Implementing tobacco use treatment guidelines in community health centers in Viet

描述（由申请人提供）：越南的吸烟率在东南亚国家（SEAC）中排名第二。越南人口约为9000万，是东南亚第二大成年吸烟者总数（超过1600万）。据世界卫生组织（世卫组织）称，在不久的将来，烟草使用死亡率的大部分降低将通过帮助目前的使用者戒烟来实现。根据美国预防健康服务指南（指南）关于治疗烟草使用和依赖的定义，烟草使用治疗是以证据为基础的，具有高度的成本效益。然而，在美国和全球范围内，采用推荐护理是次优的。本提案的目的是填补 通过进行一项随机对照试验，比较两种实用且高度可复制的策略的有效性和成本效益，以实施越南公共卫生诊所治疗烟草使用的循证指南，从而缩小目前研究与实践之间的差距。拟议的实施战略借鉴了循证方法和世卫组织最近发布的实施《烟草控制框架公约》第14条的指导方针。烟草控制框架公约是世卫组织为应对烟草流行全球化而制定的一项以证据为基础的条约。越南于2004年批准了《烟草控制框架公约》，但尚未采取措施实施第14条，该条规定需要将治疗烟草使用和依赖的最佳做法纳入常规预防护理。拟议的实施战略还建立在越来越多的文献的基础上，这些文献支持将社区卫生工作者纳入卫生保健团队以改善获得预防服务的有效性。我们提出了一个两组，集群随机对照试验，将比较实施烟草使用治疗指南的两种多组分策略的有效性和成本效益：1）技术援助，培训，加上临床提醒系统（TTC）vs. 2）TTC +转介给社区卫生工作者（CHW）。主要结果是提供者遵守烟草使用治疗指南（实施有效性）。次要结果是6个月的生化证实戒烟。我们将在实施评估之前进行形成性评估，以评估当前的政策，护理系统和实践层面的障碍和促进因素 在公共卫生诊所进行烟草使用筛查和治疗，并为实施战略的修改提供信息。在创新实施的组织模型的指导下，我们还将研究与有效实施烟草使用治疗指南的供应商依从性相关的组织因素。这项研究将在两个地区（农村和城市）的26个公共卫生诊所进行。这项研究的长期目标是提供关键的新知识，以促进全球和美国循证烟草使用治疗策略的广泛实施，传播和持续利用。

DESCRIPTION (provided by applicant): Vietnam has a smoking prevalence that is the second highest among South East Asian countries (SEACs). With a population of approximately 90 million, Vietnam also has the second largest total number of adult smokers (over 16 million) in SEA. According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Tobacco use treatment, as defined by the U.S. Preventive Health Service Guideline (Guideline) on Treating Tobacco use and Dependence, is evidence-based and highly cost-effective. Yet, in the U.S. and globally, adoption of recommended care is suboptimal. The objective of this proposal is to fill the current research-to-practice gap by conducting a randomized controlled trial that compares the effectiveness and cost effectiveness of two practical and highly replicable strategies for implementing evidence-based guidelines for the treatment of tobacco use in public health clinics in Vietnam. The proposed implementation strategies draw on evidence- based approaches, and the WHO's recently released guidelines for implementing Article 14 of the Framework Convention on Tobacco Control (FCTC). The FCTC is an evidence-based treaty that was developed by the WHO in response to the globalization of the tobacco epidemic. Vietnam ratified the FCTC in 2004; however, they have not taken steps to implement Article 14 which specifies the need to integrate best practices for treating tobacco use and dependence into routine preventive care. The proposed implementation strategies also build on the growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We propose a two arm, cluster randomized controlled trial that will compare the effectiveness and cost effectiveness of two multi component strategies for implementing tobacco use treatment guidelines: 1) Technical assistance, training, plus clinical reminder system (TTC) vs. 2) TTC + referral to a community health worker (CHW). The primary outcome is provider adherence to tobacco use treatment guidelines (implementation effectiveness). The secondary outcome is six month biochemically verified smoking abstinence. We will conduct a formative evaluation prior to implementation to evaluation to assess current policies, systems of care and practice-level barriers and facilitators for tobacco use screening and treatment in public health clinics and inform modifications to the implementation strategies. Guided by an organizational model of innovation implementation, we will also examine organizational factors associated with effective implementation of provider adherence to tobacco use treatment guidelines. The study will be conducted in 26 public health clinics in two districts (rural and urban). The long-term goal of this research is to provide critial new knowledge to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based tobacco use treatment strategies globally and in the U.S.