Text messaging to engage and retain Veterans in smoking cessation counseling

摘要 烟草使用仍然是美国过早死亡和发病的头号原因，以及 与烟草有关的疾病占退伍军人管理局所有医疗费用的24%。退伍军人管理局一直是解决 烟草使用，实施了年度烟草筛查，并使药物治疗变得容易。 然而，最具成本效益的服务之一--电话退出线路--仍然严重未得到充分利用。一些 退伍军人注册参加电话咨询，帮助他们戒烟，并在开始打电话的退伍军人中注册 咨询，很少有人完成完整的课程。电子健康记录(EHR)的出现使新的 确保患者获得预防性服务的战略。这些方法可以减轻提供商的负担 并弥合保健系统中的差距。我们的研究团队已经使用EHR进行了大量研究，以确定 吸烟者和主动伸出援手，协调电话烟草治疗。虽然我们已经成功地 实施这一方法后，咨询的总体入学率仍然很低，大多数吸烟者 只完成一次咨询。因此，我们建议测试新的移动健康策略，以促进 参加并坚持电话咨询。具体目标是：1)按顺序进行 评估短信在增加注册和遵守方面的有效性的随机试验 电话戒烟治疗，2)比较接受治疗和接受治疗的患者的戒烟率 在治疗过程中不会收到短信，以及3)评估患者使用这些干预措施的经历。 使用退伍军人事务部电子健康记录，我们将识别退伍军人事务部三个地点的N=3,600名吸烟者。所有确认身份的吸烟者都将收到一封 包含研究信息的介绍性包。没有选择退出的患者将首先被随机分配到 标准电话外展咨询或收到8条教育文本，以应对参与障碍 在电话外展前进行咨询。参加烟草治疗的患者随后将被随机分配到 接受标准的电话咨询或还会收到预约提醒和支持性短信 在为期8周的咨询期间。我们假设，这些方法将增加 参加电话戒烟和经过生化验证的12个月戒烟(初级) 结果)而不是标准的电话咨询方法。我们还将评估每个患者的体验 短信协议。我们的首要目标是为越来越多的退伍军人研究创新的移动健康策略 使用基于电话的戒烟咨询，以提高戒烟率。这项研究，探索两者 以人口为基础的外展和短信，推进退伍军人管理局蓝图为 太棒了。结果将对决策和基于人口的护理模式产生直接影响 用于烟草治疗。

ABSTRACT Tobacco use remains the number one cause of premature death and morbidity in the United States, and tobacco-related diseases account for 24% of all VA healthcare costs. The VA has been a leader in addressing tobacco use, having implemented annual tobacco screening and made pharmacotherapy readily available. However, one of the most cost-effective services - telephone quit lines - remain highly underused. Few Veterans enroll in telephone counseling to help them quit smoking, and among Veterans who begin telephone counseling, few complete a full course. The advent of electronic health records (EHRs) has enabled new strategies for ensuring that patients receive preventive services. These methods can reduce provider burden and close gaps in systems of care. Our research team has conducted numerous studies using EHRs to identify smokers and proactively reach out to coordinate telephone tobacco treatment. While we have successfully implemented this approach, the overall enrollment rates for counseling remain low and the majority of smokers complete only one counseling session. Therefore, we propose to test novel mHealth strategies for promoting enrollment in and adherence to telephone counseling. The Specific Aims are to: 1) Conduct a sequentially randomized trail to estimate the effectiveness of text messaging for increasing enrollment in and adherence to telephone tobacco treatment, 2) Compare rates of tobacco cessation between patients who received and did not receive text messaging during treatment, and 3) Evaluate patient experiences with these interventions. Using the VA EHR, we will identify N=3,600 smokers at three VA sites. All identified smokers will be mailed an introductory packet with information about the study. Patients who do not opt out will first be randomized to standard telephone outreach for counseling or to receive 8 educational texts to counter barriers of participating in counseling prior to telephone outreach. Patients who enroll in tobacco treatment will then be randomized to receive standard telephone counseling or to also receive appointment reminders and supportive texts throughout the 8-week counseling period. We hypothesize that these approaches will increase the rate of enrollment in telephone tobacco cessation and 12-month biochemically validated abstinence (primary outcomes) over standard telephone counseling approaches. We will also assess patient experiences with each texting protocol. Our overarching goal is to investigative innovative mHealth strategies for increasing Veteran use of telephone-based tobacco cessation counseling and to improve quit rates. This research, exploring both population-based outreach and text messaging, advances multiple goals set forth by the VA’s Blueprint for Excellence. Results will have direct implications to inform decision-making and population-based care models for tobacco treatment.