Extended Care for Smoking Cessation Following Psychiatric Hospitalization

描述(申请人提供)：精神障碍患者的吸烟率比一般人群高得不成比例。事实上，这些人是 据估计，他们消费了美国几乎一半(44.3%)的香烟，他们的寿命比一般人短25-32岁。2011年，180万美国成年人接受了住院精神治疗，其中包括7.2%患有严重精神疾病(SMI)的成年人。大多数精神病院在医院内禁止吸烟，从而为住院患者提供了经历戒烟的机会。然而，精神科住院的吸烟者很少在出院时得到戒烟治疗的转介(1%)，大多数人在出院后恢复吸烟。因此，将有效的戒烟干预措施纳入当前的精神卫生治疗系统是公共卫生的优先事项。我们最近描述了一项在住院内科患者中进行的比较有效性试验，将标准护理与长期护理吸烟干预进行了比较，后者免费为患者提供长达3个月的戒烟药物，以及5个主动的、计算机化的电话，在此期间，患者可以要求收到现场顾问的回电。这种延伸护理服务显示了临床有效性，在出院6个月后，与标准护理相比，产生了显著更多的生化验证的、点流行的戒断。该项目的总体目标是使这种延长护理(EXC)模式适用于接受精神病住院治疗的SMI吸烟者，并进行一项随机、实用的有效性试验，旨在评估这种经过调整的EXC在现实世界实践中的益处。我们将测试这一假设，即在住院精神治疗中患有SMI的吸烟者(n=422)中，与接受关于戒烟的简短教育(BE)的组相比，EXC将导致在6个月和12个月时接受可替宁验证的7天点戒烟率显著更高。此外，我们假设，在出院后的一个月内，更高比例的EXC患者和BE患者将使用循证戒烟治疗(咨询和药物治疗)。我们亦会探讨执行执行委员会在出院后12个月内对健康及医疗服务利用的影响(精神症状、精神科及内科再入院及急诊室就诊)，以及执行委员会对诊断组别患者戒烟的效果。该项目的预期结果是对精神病住院后SMI患者实施延长护理干预戒烟的有效性的展示。未来的研究可能会将这些发现扩展到接受门诊精神治疗或心理治疗的SMI患者。总体而言，这项研究将对公共卫生产生重大的积极影响，使我们更接近传播和整合延伸护理模式的长期目标，以增加戒烟并降低严重精神疾病患者的吸烟相关发病率和死亡率。

DESCRIPTION (provided by applicant): Smoking rates among individuals with psychiatric disorders are disproportionately higher than the general population. In fact, these individuals are estimated to consume almost half (44.3%) of all cigarettes smoked in the U.S. and have lifespans 25 - 32 years shorter than the general population. In 2011, 1.8 million U.S. adults, including 7.2% of adults with severe mental illness (SMI), received inpatient psychiatric treatment. The majority of psychiatric hospitals ban smoking on hospital grounds, thus providing an opportunity for inpatients to experience abstinence. Yet smokers in inpatient psychiatric settings are infrequently provided with referrals for cessation treatment on discharge (< 1 %) and most resume smoking upon discharge. Therefore, the integration of effective cessation interventions within the current mental health treatment system is a public health priority. We have recently described and have now completed a comparative effectiveness trial in hospitalized medical patients, comparing Standard Care to an Extended Care smoking intervention that provided up to 3 months of smoking cessation medication at no cost to patients and 5 proactive, computerized telephone calls during which patients could request to receive a call back from a live counselor. This Extended Care service demonstrated clinical effectiveness, yielding significantly greater biochemically-verified, point prevalence abstinence relative to Standard Care, 6 months after hospital discharge. The overall objective of this project is to adapt this Extended Care (ExC) model to smokers with SMI engaged in a psychiatric hospitalization and to conduct a randomized, pragmatic effectiveness trial designed to assess the benefit of this adapted ExC in real-world practice. We will test the hypothesis that, among smokers with SMI in inpatient psychiatric treatment (n = 422), ExC will result in significantly greater rates of cotinine- validated, 7-day point prevalence abstinence at 6- and 12-months compared to a group that receives Brief Education (BE) about smoking cessation. Furthermore, we hypothesize that a higher proportion of ExC vs. BE patients will use evidence-based smoking cessation treatment (counseling and pharmacotherapy) in the month after discharge. We will also explore the effect of ExC on health and health care utilization in the 12 months post-discharge (psychiatric symptoms, psychiatric and medical hospital readmissions and emergency room visits) and the effectiveness of ExC on smoking abstinence in patient diagnostic subgroups. The expected outcome of this project is a demonstration of the effectiveness of an Extended Care intervention for smoking cessation in individuals with SMI following psychiatric hospitalization. Future studies could extend these findings to individuals with SMI receiving outpatient psychiatric treatment or psychotherapy. Overall, this research would have a significant positive public health impact that will move us closer to the long- term goal of dissemination and integration of the Extended Care model to increase smoking cessation and decrease smoking related morbidity and mortality in people with severe mental illness.