TOBACCO TREATMENT OUTREACH TO REDUCE DISPARITIES FOR PRIMARY CARE POPULATIONS

项目总结： 在美国，吸烟仍然是主要的可预防的死亡原因，而且是公认的 肺癌的起因。尽管吸烟率在过去几十年里有所下降，但仍有 吸烟方面的巨大差距。重要的是，低社会经济地位(SES)和少数族裔吸烟者 由于各种原因而更难戒烟，包括获得治疗的机会更有限，错误信息 关于治疗选择的风险和好处，更多的环境暴露，缺乏社会支持，以及 其他生活压力源。虽然大多数吸烟者每年都会去看初级保健医生，但忙碌的临床医生 在访问期间经常不涉及烟草使用问题。少数族裔和低SES吸烟者比白人更有可能吸烟 报告他们在探视期间没有接受咨询或治疗。出于这些原因，重要的是 在服务提供者办公室之外为烟草治疗提供系统的机会。 交互式语音应答(IVR)是一种允许计算机检测语音应答的电话技术 在一个普通的电话里。这项技术提供了一种低成本、高效的方式来主动接触大型企业 人口，独立于一次访问。该项目的目标是开发和评估一个多层次的 低SES和少数族裔患者的烟草治疗方法。这些组件包括：(1)IVR促进 系统性推广，与烟草治疗专家的联系，以及指导的免费尼古丁替代疗法 (2)通过具有综合烟草相关决策支持的电子健康记录(EHR)与个人的初级保健医生(EHR)进行整合，以及(3)转介到量身定制的社区资源，以解决戒烟的社会背景障碍。 因此，我们提出了以下具体目标：具体目标1：为低SES和少数吸烟者开发一个与EHR相关的、IVR中介的定制烟草治疗计划。具体目标2：通过在以合作伙伴初级保健实践为基础的研究网络中对低SES和少数吸烟者进行随机对照试验，衡量这一量身定制治疗计划的有效性。这项试验的主要结果将是6个月的7天禁酒率。具体目标3：评估影响、采用和实施这一量身定制的烟草治疗计划的促进者和障碍。

Project Summary: Smoking remains the leading preventable cause of death in the United States (US), and is a well established cause of lung cancer. Although smoking rates have declined over the past several decades, there remain substantial disparities in smoking . Importantly, low socioeconomic status (SES) and minority smokers have a more difficult time quitting for a variety of reasons including more limited access to treatment, misinformation about the risks and benefits of treatment options, more environmental exposure, lack of social support, and other life stressors. While the majority of smokers visit a primary care physicain each year, busy clinicians frequently do not address tobacco use during a visit. Minority and low SES smokers are more likely than whites to report that they did not receive counseling or treatment during a visit. For these reasons it is important to offer systematic opportunities for tobacco treatment beyond the provider's office. Interactive Voice Response (IVR) is a phone technology that allows a computer to detect voice responses during a normal phone call. This technology offers a low-cost, efficient way to proactively reach out to large populations, independent of a visit. The objectives of this project are to develop and evaluate a multi-level approach to tobacco treatment for low-SES and minority patients. The components include: (1) IVR-facilitated systematic outreach, linkage to a tobacco treatment specialist, and free nicotine replacement therapy directed at the patient, and integration of this program with both (2) an individual's primary care physician through an electronic health record (EHR) with integrated tobacco-related decision support, and (3) referral to tailored community resources to address the socio-contextual barriers to tobacco cessation. We therefore propose the following Specific Aims: Specific Aim 1: To develop an EHR-linked, IVR-mediated tailored tobacco treatment program for low-SES and minority smokers. Specific Aim 2: To measure the effectiveness of this tailored treatment program by conducting a randomized controlled trial of low SES and minority smokers in the Partners Primary Care Practice Based Research Network. The primary outcome of this trial will be the 7-day abstinence rate at 6 months. Specific Aim 3: To evaluate facilitators and barriers to the reach, adoption, and implementation of this tailored tobacco treatment program.