Project 1: Optimizing Smoking Cessation Treatment in Primary Care: A Factorial Screening Experiment (Cessation Screening)

项目摘要 在美国，烟草使用是导致过早死亡和癌症死亡的主要可预防原因。 大多数吸烟者每年都会访问医疗机构，提供了无与伦比的干预机会。然而，大多数 吸烟者在他们的健康护理访问期间没有得到高效的戒烟治疗。提高 吸烟治疗在医疗保健中的有效性，该项目将确定特别有前途的药物 方案和咨询方式用于初级保健的两个最有效的戒烟 药物治疗：伐尼克兰和联合尼古丁替代疗法（C-NRT）。的标准 确定有前途的伐尼克兰和C-NRT治疗将包括1年的生化证实点- 患病率、禁欲率和费用。来自初级保健诊所想要戒烟的吸烟者（N=608）将接受 随机接受以下四个因素的两个水平之一：1）药物类型（伐尼克兰与C-NRT），2） 准备用药（4周vs.标准），3）用药持续时间（延长[24周] vs.标准[12 周]）和4）咨询方式（面对面与电话）。这项拟议中的研究建立在我们的专业知识基础上 和以前的研究结果，以解决一个关键的知识差距：即，如何最有效地利用 戒烟药物治疗在现实世界的医疗环境。这项研究将使用一个有效的和 创新方法（即，多阶段优化策略），以确定最有前途的C-NRT， 基于伐伦克林的治疗用于吸烟的初级保健患者。这些特别有前途的 然后，将在2010年的优化护理项目中的随机临床试验中评估（“优化”）治疗。 这个计划项目。

Project Summary Tobacco use is the leading preventable cause of both premature deaths overall and cancer deaths in the US. Most smokers visit a healthcare setting each year, providing an unequaled opportunity to intervene. Yet, most smokers do not receive highly effective cessation treatment during their healthcare visits. To improve the effectiveness of smoking treatment in healthcare, this project will identify especially promising medication regimens and counseling modalities for use in primary care for the two most effective smoking cessation pharmacotherapies: varenicline and combination nicotine replacement therapy (C-NRT). The criteria for identifying promising varenicline and C-NRT treatments will include 1-year biochemically confirmed point- prevalence abstinence and cost. Smokers (N=608) from primary care clinics, who want to quit smoking, will be randomized to receive one of two levels of each of four factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 weeks vs. Standard), 3) Medication Duration (Extended [24 weeks] vs. Standard [12 weeks]), and 4) Counseling Modality (In-Person vs. Phone). The proposed research builds on our expertise and prior research findings to address a critical knowledge gap: i.e., how best to use the most effective smoking cessation pharmacotherapies in real-world healthcare settings. This research will use an efficient and innovative methodology (i.e., the Multiphase Optimization Strategy) to identify the most promising C-NRT and varenicline-based treatments to use with primary care patients who smoke. These especially promising (“optimized”) treatments will then be evaluated in a randomized clinical trial in the Optimized Care Project of this Program Project.