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

描述(申请人提供)：这项研究测试了手持电脑平板电脑的使用，以促进5A戒烟在学术和社区初级保健诊所的整合。虽然大多数患者接受了“询问”和“建议”的步骤，但只有略多于一半的患者接受了准备改变的“评估”，不到一半的患者接受了改变的“帮助”，只有9%的患者得到了“安排”的随访。虽然绝大多数初级保健提供者支持5A的模式，但负面态度以及缺乏时间、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，以提高提供商的忠诚度和5A的保真度。这项提案开发和测试了一个计算机辅助的5A(CF-5A)模型，该模型管理5A对患者的干预，然后提示提供者加强下一步的工作。CF-5A可以有效地促进戒烟，同时教育提供者戒烟资源和适当的后续行动。在技术接受模型的基础上，将制定和测试临床上量身定做的战略，以促进CF-5A的实施，以确保这一新服务交付模式的适当使用和采用。尽管这项研究的重点是戒烟的5A，但这项研究考察了计算机辅助服务交付模式的潜在实施科学，对将其他物质使用或行为健康干预整合到初级保健中具有重要意义。仔细的、混合的方法探索和关键实施因素的测试被用来帮助建立基于证据的战略，以改善初级保健环境中行为健康服务的整合。这项实施研究的目标将在4个具体目标中实现：目标1：开发计算机辅助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。目的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，评价CF-5A的服务提供模式。目标3：使用混合方法设计，确定和评估个人、临床和系统层面的实施结果和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‘s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.