Computer-Facilitated 5A's for Smoking Cessation in Primary Care

描述（由申请人提供）：本研究测试使用手持电脑平板电脑，以促进学术和社区初级保健诊所戒烟5A的整合。虽然大多数患者接受了“询问”和“建议”步骤，但只有略多于一半的患者接受了“评估”以准备改变，不到一半的患者在改变时得到了“帮助”，只有9%的患者得到了“安排”的随访。虽然大多数初级保健提供者支持5A的模式，但消极的态度和缺乏时间，知识和戒烟技能是常见的障碍。需要解决这些障碍的替代服务提供系统和促进其实施的循证战略，以提高提供者的依从性和5A的忠诚度。 该提案开发并测试了一种计算机辅助的5A（CF-5A）模型，该模型将5A的干预管理到患者，然后提示提供者加强下一步。CF-5A可以有效地促进戒烟，同时教育提供者有关戒烟资源和适当的后续行动。根据技术接受模式，将制定和测试临床上量身定制的战略，以促进CF-5A的实施，以确保适当使用和吸收这一新的服务提供模式。 虽然专注于5A的戒烟，本研究探讨了计算机辅助服务提供模式的基本实施科学与其他物质的使用或行为健康干预措施在初级保健的整合具有重要意义。一个仔细的，混合的方法探索和测试的关键实施因素是用来帮助建立以证据为基础的战略，以改善初级保健环境中的行为健康服务的整合。本实施研究的目标将在4个具体目标中实现：目标1：制定计算机辅助5A（CF-5A）服务提供模式和实施计划，以促进初级保健中的戒烟。目标2：通过比较学术和社区初级保健诊所的随机干预和对照提供者，评估CF-5A的服务提供模式。目标3：使用混合方法设计识别和评估个人、诊所和系统级实施结果以及实施成功的预测因素。目标4：向全国学术和社区诊所样本传播CF-5A和实施干预措施。

DESCRIPTION (provided by applicant): This study tests the use of handheld computer tablets to promote the integration of 5A's for smoking cessation in academic and community primary care clinics. Although most patients receive the "ask" and "advise" steps, only slightly more than half are "assessed" for readiness to change, less than half receive "assistance" in changing, and only 9% have an "arranged" follow-up. While the large majority of primary care providers support the 5A's model, negative attitudes and the lack of time, knowledge, and cessation skills are common obstacles. Alternate service delivery systems that address these obstacles and evidence-based strategies to promote their implementation are needed to improve provider adherence and 5A's fidelity. This proposal develops and tests a computer-facilitated 5A's (CF-5A's) model that administers the 5A's intervention to patients then prompts providers for reinforcing next steps. CF-5A's could efficiently and effectively promote smoking cessation while educating providers about cessation resources and appropriate follow-up. Based on the Technology Acceptance Model, clinically tailored strategies to promote CF-5A's implementation will be developed and tested to ensure the appropriate use and uptake of this new service delivery model. Although focused on 5A's for smoking cessation, this study examines the underlying implementation science of computer-aided service delivery models with important implications for the integration of other substance use or behavioral health interventions in primary care. A careful, mixed methods exploration and testing of key implementation factors is used to help build evidence-based strategies to improve the integration of behavioral health services in primary care settings. The goals of this implementation study will be achieved in 4 specific aims: AIM 1: Develop a computer facilitated 5A's (CF-5A's) service delivery model and implementation plan to promote smoking cessation in primary care. AIM 2: Evaluate the CF-5A's service delivery model by comparing randomized intervention and control providers in academic and community primary care clinics. AIM 3: Identify and evaluate individual, clinic, and systems level implementation outcomes and predictors of implementation success using a mixed methods design. AIM 4: Disseminate the CF-5A's and implementation interventions to a national sample of academic and community clinics.