Implementation and Dissemination of Tobacco Cessation Strategies in Free Clinics

描述(由申请人提供)：没有健康保险的人吸烟的可能性是通过私人提供者投保的人的1}倍，并且不太可能从健康专业人员那里获得戒烟建议。没有保险的人获得戒烟计划的机会有限，可能会导致他们过度的疾病负担和更差的存活率。本研究的目的是通过实现以下目标，为在免费诊所实施和传播循证戒烟策略提供形成数据：(1)提高免费诊所采用美国公共卫生服务关于治疗烟草使用和依赖的指南的组织意愿；(2)评估循证策略在诊所健康护理志愿者和未参保患者中促进戒烟行为的有效性；以及(3)测试北卡罗来纳州免费诊所协会是否有能力在大学研究团队缺席的情况下传播基于证据的烟草预防和戒烟策略。这些目标将通过一项随机对照试验设计来实现，该试验设计将在六个免费诊所测试以诊所为基础的戒烟策略的采用、效果和传播。这些目标将使用三种数据收集方案进行评估，包括关键线人访谈、环境扫描和患者出口访谈。免费诊所在为美国未参保人口提供医疗保健方面起着至关重要的作用。它们是非营利性私营实体，与其他安全网提供者不同，因为它们不接受任何第三方付款人的补偿，不向患者收取医疗服务费用，并广泛依赖志愿医疗专业人员。2006年，北卡罗来纳州的免费诊所接待了30多万名患者。在北卡罗来纳州提供医疗或牙科护理的55家免费诊所中，只有四分之一的诊所提供戒烟服务，只有两家在现场提供全面的戒烟计划。拟议的研究报告回应了成功实施和传播针对未参保者的循证戒烟护理的未得到满足的需求。这项研究的总体目的是最终弥合烟草控制领域的研究发现和项目交付之间的差距。公共卫生相关性：科学证据表明，以诊所为基础的综合干预措施显著提高了吸烟患者的戒烟率。证据也令人信服，没有医疗保险的个人接受戒烟咨询的可能性较小，但使用烟草的人数是一般人口的1}倍以上。这项研究将测试循证临床实践指南在免费诊所环境中的实施和传播情况，从而对未参保者的健康产生显著的积极影响。

DESCRIPTION (provided by applicant): Individuals without health insurance are 1} times more likely to smoke than those insured through private providers and are less likely to receive smoking cessation advice from a health professional. Limited access to smoking cessation programs among the uninsured may contribute to their excess disease burden and poorer survival. The goal of this research is to provide formative data on the implementation and dissemination of evidence-based tobacco cessation strategies in free clinics by achieving the following aims: (1) increasing free clinics' organizational readiness to adopt the United States Public Health Service's Guidelines on Treating Tobacco Use and Dependence; (2) evaluating the efficacy of the evidence-based strategies in promoting tobacco cessation behaviors among the clinics' health care volunteers and uninsured patients; and (3) testing whether the North Carolina Association of Free Clinics has the capacity to disseminate the evidence-based tobacco prevention and cessation strategies in absence of the university research team. These aims will be accomplished through a randomized, controlled trial design to test the adoption, efficacy, and dissemination of clinic-based tobacco cessation strategies in six free clinics. These aims will be evaluated using three data collection protocols including key informant interviews, environmental scans, and patient exit interviews. Free clinics serve a critical role in health care delivery of America's uninsured population. They are non-profit private entities distinct from other safety net providers in that they do not accept reimbursement from any third-party payors, do not charge patients for health care services, and rely extensively on volunteer health care professionals. More than 300,000 patient visits occurred in North Carolina's free clinics in 2006. Of 55 free clinics in North Carolina providing medical or dental care , only one out of four clinics offers any tobacco cessation services and only two have a comprehensive tobacco cessation program onsite. The proposed research study responds to an unmet need for the successful implementation and dissemination of evidence-based tobacco cessation care for the uninsured. The overall intent of this research is to ultimately close the gap between research discovery and program delivery in the area of tobacco control. PUBLIC HEALTH RELEVANCE: The scientific evidence demonstrates that comprehensive clinic-based interventions significantly improve quit rates among tobacco-using patients. The evidence is also compelling that individuals without health insurance are less likely to receive tobacco cessation counseling, yet are more than 1 } times the general population to use tobacco. This study will test the implementation and dissemination of evidence-based clinical practice guidelines in the free clinic setting, whereby having a significantly positive impact on the health of the uninsured.