ASK, ADVISE, REFER: Promoting Pharmacy-based Referrals to Tobacco Quitlines

描述（由申请人提供）：社区药房作为卫生保健系统和公众之间的关键接口，具有显著降低烟草使用流行率的潜力，特别是在烟草使用是需要处方药的疾病发展或恶化的主要风险因素的关键人群中。虽然繁忙的社区药房环境通常不利于全面的戒烟咨询，但它可能是广泛实施简短干预措施的理想场所，例如询问烟草使用情况，建议患者戒烟，并将患者转介到免费戒烟热线。在拟议的研究中，我们将扩大与加州大学旧金山分校戒烟领导中心的持续合作，并将与全国公认的电话咨询服务提供商Free & Clear合作。我们提出了一项随机试验，以评估两种干预方法对产生基于药房的戒烟热线转诊的影响：最小干预：通过邮件向药房提供打印的戒烟热线材料，由药房人员分发给吸烟的患者；学术详细说明：药房人员通过简短的现场培训，获得与最小干预组平行的打印材料和模拟转诊程序的DVD演示。康涅狄格州（n=24）和华盛顿州（n=24）的社区药房将构成研究人群。干预措施的影响将通过以下措施进行评估：(a)向患者提供的戒烟热线转诊卡的数量，(b)来自每个参与药房的戒烟热线来电数量，以及(c)来自每个药房的戒烟热线咨询注册人数。此外，我们将对每个站点的药剂师和药房职员/技术人员进行纵向调查，以评估自我报告的戒烟咨询和患者转诊行为，并确定与自我报告的戒烟线转诊做法相关的因素。本以社区为基础的干预研究所提倡的“询问-建议-转诊”模式是一种整合到日常药学实践的可行方法。在全国范围内，超过5万家社区药店雇佣了大约14.4万名药剂师。如果每个药剂师每周只推荐一个病人到戒烟热线，这将导致每年近750万的转诊。公共卫生相关性：社区药房作为卫生保健系统与普通公众之间的关键接口，具有显著降低烟草使用流行率的潜力，特别是在烟草使用是需要处方药的疾病（如心血管疾病、肺病和糖尿病）发展或恶化的主要风险因素的关键人群中。拟议的项目将评估一项干预措施，以促进以药房为基础的转介到戒烟热线，从而使药房专业人员在减少美国烟草使用流行方面发挥更积极的作用。

DESCRIPTION (provided by applicant): Community pharmacies, as a key interface between the health-care system and the general public, have the potential to substantially reduce the prevalence of tobacco use-particularly among key population groups for which tobacco use is a major risk factor for development or exacerbation of diseases requiring prescription medications. While the busy community pharmacy environment is not typically conducive to comprehensive tobacco cessation counseling, it might be ideal for widespread implementation of brief interventions, such as asking about tobacco use, advising patients to quit, and referring patients to toll-free tobacco quitlines. In the proposed study, we will expand upon our ongoing collaboration with the UCSF Smoking Cessation Leadership Center and will team with Free & Clear, a nationally recognized provider of telephone-based counseling services. We propose a randomized trial to estimate the impact of two intervention approaches for generating pharmacy-based referrals to tobacco quitlines: MINIMAL INTERVENTION: pharmacies are provided, by mail, with printed quitline materials to be distributed by pharmacy personnel to patients who smoke, and ACADEMIC DETAILING: pharmacy personnel receive, via brief on-site training, print materials that parallel the minimal intervention group and DVD demonstrations that model the referral procedures. Community pharmacies in Connecticut (n=24) and Washington (n=24) will comprise the study population. Intervention impact will be assessed through measures of (a) the number of quitline referral cards provided to patients, (b) the number of incoming calls to the quitline originating from each participating pharmacy, and (c) the number of quitline counseling registrants that originate from each pharmacy. In addition, we will conduct a longitudinal survey of pharmacists and pharmacy clerks/technicians at each site, to assess self-reported tobacco cessation counseling and patient referral behavior and to identify factors associated with self-reported quitline referral practices. The Ask-Advise-Refer model to be advocated in this community-based intervention study is a feasible approach for integration into routine pharmacy practice. Nationwide, more than 50,000 community pharmacies employ approximately 144,000 pharmacists. If each pharmacist were to refer just one patient per week to a quitline, this would result in nearly 7.5 million referrals annually. PUBLIC HEALTH RELEVANCE: Community pharmacies, as a key interface between the health-care system and the general public, have the potential to substantially reduce the prevalence of tobacco use-particularly among key population groups for which tobacco use is a major risk factor for development or exacerbation of diseases requiring prescription medications (e.g., cardiovascular disease, pulmonary disease, and diabetes). The proposed project will evaluate an intervention to promote pharmacy-based referrals to tobacco quitlines, thereby engaging the pharmacy profession in taking a more active role toward reducing the prevalence of tobacco use in the United States.