Treatment Engagement Intervention for Smokers with Psychiatric Disorders

 描述（由申请人提供）： 背景资料：研究一致表明，患有精神疾病的人吸烟率大大高于一般人群。尽管意识到烟草使用率高，精神障碍患者承受的烟草相关疾病负担不成比例，但针对这种健康差异的研究有限。雅阁表明，大多数患有精神疾病的吸烟者表达了戒烟的愿望，VHA一直是将戒烟服务纳入医疗保健环境的国家领导者，并且越来越多地解决患有精神疾病的退伍军人的烟草使用问题。然而，患有精神疾病的吸烟者的治疗利用率很低;对转介到VA圣地亚哥医疗保健系统（VASDHS）的患有精神疾病的退伍军人戒烟计划的审查表明，2012年8月1日至2013年7月31日期间转诊治疗的638名患者中有113名在转诊完成后30天内进行了戒烟治疗。这一点尤其令人担忧，因为对精神病人群的现有研究表明，对一般人群有效的治疗方法，包括行为和药物干预，对患有精神疾病的吸烟者也有效。虽然大多数有动机的吸烟者可能会尝试自己戒烟，但让吸烟者接触结构化治疗可能会 提高成功几率。因此，让患有精神疾病的吸烟者参与戒烟的正式治疗是一个对VA特别重要和相关的问题。目的：本研究项目的目的是开发一种通过电话提供的简短干预措施，以促进门诊戒烟治疗的参与。治疗开发将通过调整现有的、面对面的方案和对退伍军人参与戒烟治疗的促进者和障碍的定性评估来了解 患有精神疾病由此产生的干预措施将用于未来的临床试验。 主要目的：该试点项目的主要目的是采用一个连续的定性治疗开发程序，以适应电话交付现有的面对面干预，以提高烟草使用治疗的参与。其目的是制定一个手动的治疗方案和电话脚本进行干预。 次要目的：为后续随机试验建立受试者招募和入组程序，并获得初步治疗参与数据。研究方法：这是一个定性的治疗开发项目，采用顺序设计，其中来自连续阶段的信息将用于完善干预内容和交付。参与者将包括50名患有精神疾病的资深烟草使用者。参与者将从心理健康诊所和VA圣地亚哥医疗保健系统（VASDHS）门诊戒烟治疗的个人中招募。我们将调整为因抑郁症住院的烟草使用者开发的治疗参与干预。将通过定性研究，包括焦点小组和干预措施的试点实施以及电话“回拨”访谈，了解针对电话交付的治疗参与干预措施的适应情况。将进行焦点小组访谈，以探讨退伍军人认为是参与戒烟治疗计划的潜在障碍和促进因素。将使用回调访谈来完善最终的治疗方案。

 DESCRIPTION (provided by applicant): Background: Research consistently indicates that individuals with psychiatric disorders smoke at rates substantially higher than those of the general population. Despite awareness of the high rates of tobacco use and disproportionate burden of tobacco related disease burden borne by individuals with psychiatric disorders, limited research has addressed this health disparity. In accord with evidence that the majority of smokers with psychiatric disorders express a desire to quit smoking, the VHA has been a national leader for integration of smoking-cessation services in health care settings, and increasingly is addressing tobacco use among veterans with psychiatric disorders. However, rates of treatment utilization by smokers with psychiatric disorders are low; a review of referrals to VA San Diego Healthcare System (VASDHS) tobacco cessation program for veterans with psychiatric disorders indicated that only 16.2% (113 of 638) of patients referred for treatment between August 1, 2012 and July 31, 2013 engaged in smoking cessation treatment within 30 days of referral completion. This is of particular concern as existing research with psychiatric populations indicates that treatment approaches found effective for the general population, including both behavioral and pharmacologic intervention, are also effective for smokers with psychiatric disorders. While a majority of motivated smokers may attempt to quit on their own, putting smokers in contact with structured treatments will likely improve odds of success. As such, engaging smokers with psychiatric disorders in formal treatment for tobacco cessation is an issue of particular importance and relevance to VA. Objectives: The objective of this research project is to develop a brief intervention delivered by telephone to facilitate engagement in outpatient tobacco cessation treatment. Treatment development will be informed by adaptation of an existing, in-person, protocol and qualitative evaluation of facilitators and barriers to participation in tobacco cessation treatment by veterans with psychiatric disorders. The resulting intervention will be utilized in future clinical trials. Primary Aim:The primary aim of this pilot project is to employ a sequential qualitative treatment development procedure in order to adapt for telephone delivery an existing in-person intervention for enhancing tobacco use treatment participation. The aim is to produce a manualized treatment protocol and telephone script for intervention delivery. Secondary Aim: to establish participant recruitment and enrollment procedures for a subsequent randomized trial and to obtain preliminary treatment engagement data. Methods: This is a qualitative treatment development project utilizing a sequential design where information from successive phases will be used to refine intervention content and delivery. Participants will include 50 veteran tobacco users with a psychiatric disorder. Participants will be recruited from mental health clinics and from individuals who are referred for outpatient tobacco cessation treatment in the VA San Diego Healthcare System (VASDHS). We will adapt a treatment engagement intervention developed for tobacco users hospitalized for depression. Adaptation of the treatment engagement intervention for telephone delivery will be informed by qualitative study including focus groups and pilot implementation of the intervention along with telephone "callback" interviews. Focus group interviews will be carried out to explore what veterans consider to be potential barriers and facilitators to participating in an tobacco cessation treatment programs. Callback interviews will be used to refine the final treatment protocol.