Centralized Disease Management for Rural Hospitalized Smokers

描述(由申请人提供)：住院吸烟者与持续使用烟草有关的并发症的风险很高。虽然全国的注意力都集中在住院患者的戒烟上，但乡村医院一直无法实施有效的戒烟计划的完整组成部分。在这次对Kan戒烟的竞争性更新中，我们经验丰富的多学科团队将建立在我们对农村社区戒烟研究的坚实基础上。Kan戒烟针对处于戒烟准备阶段的吸烟者，证明了免费药物治疗与药物治疗管理相结合的疾病管理可以让78%的吸烟者参与有效的治疗。不幸的是，戒烟的免费药物治疗并不是普遍可用的。州戒烟计划的供应有限，选择也有限；尽管药物治疗的处方药覆盖范围越来越广，但它没有得到充分利用，特别是在住院吸烟的高危人群中。以慢性护理模式为基础，我们修订后的疾病管理计划旨在提供咨询和疾病管理，同时增加药物治疗的利用率，并加强医疗保健提供者的支持。与菅直人的戒烟不同，我们修订后的疾病管理计划将利用社区现有的药物治疗资源。我们的具体目标是1)评估住院农村吸烟者戒烟的集中疾病管理(CDM)的有效性；2)测试CDM对药物治疗使用的影响以及与医疗保健提供者的讨论；3)阐明这些因素的使用如何调节CDM的戒烟效果；以及4)检查CDM戒烟的边际成本效益。这项研究将在堪萨斯州的30家农村关键通道医院进行。主要结果是唾液可替宁证实的7天点戒毒盛行率。住院的农村吸烟者将被随机分为CDM组或仅接受咨询组(C组)(每组303人)。所有参与者将在第3天、第7天、第21天和第90天接受住院电话咨询和电话随访。6个月后，将进行第二次努力，以重新吸引持续吸烟者或复发吸烟者。对于CDM参与者，我们的烟草治疗专家还将在住院期间和出院后提供基于电话的疾病管理，包括根据他们的保险计划为药物治疗提供补充支持，并指导他们与医疗保健提供者建立有效的讨论。烟草治疗专家还将向医疗保健提供者传真治疗建议、处方请求和咨询建议。拟议的研究将增强我们对戒烟疾病管理的理解，如果成功，有可能立即在农村关键通道医院实施。公共卫生相关性：许多住院吸烟者没有接受有效的戒烟治疗。在Kan戒烟的后续行动中，我们将观察住院吸烟者的疾病管理是否可以增加有效药物疗法的使用，改善与医疗保健提供者的沟通，并提高戒烟率。

DESCRIPTION (provided by applicant): Hospitalized smokers are at high risk for complications related to continued tobacco use. Although national attention has been directed at smoking cessation for hospitalized patients, rural hospitals have been unable to implement the complete components of effective smoking cessation programs. In this competitive renewal to Kan Quit, our experienced, multidisciplinary team will build upon our strong foundation of research on smoking cessation in rural communities. Kan Quit, directed at smokers in all stages of readiness to quit, demonstrated that disease management, in which free pharmacotherapy was combined with pharmacotherapy management, could engage 78% of smokers in effective treatment. Unfortunately, free pharmacotherapy for smoking cessation is not universally available. State smoking cessation programs have limited supplies and offer limited choices; although prescription coverage for pharmacotherapy is increasingly available, it is underutilized, particularly among the high-risk population of hospitalized smokers. Grounded in the Chronic Care Model, our revised disease management program is designed to provide counseling and disease management while increasing utilization of pharmacotherapy and enhancing support from healthcare providers. In contrast to Kan Quit, our revised disease management program will take advantage of resources for pharmacotherapy already available in the community. Our specific objectives are to 1) evaluate the effectiveness of Centralized Disease Management (CDM) for smoking cessation among hospitalized rural smokers; 2) test the impact of CDM on utilization of pharmacotherapy and discussions with health care providers; 3) clarify how utilization of these elements may mediate the effect of CDM on smoking cessation; and 4) examine the marginal cost effectiveness of CDM for smoking cessation. This study will be conducted in 30 rural critical access hospitals in Kansas. The primary outcome is 7-day point prevalence abstinence confirmed by salivary cotinine. Hospitalized rural smokers will be randomized to either CDM or counseling (C) alone (303 in each arm). All participants will receive in-hospital telephone counseling with telephone follow-up at days 3, 7, 21, and 90. A second effort will be made to re-engage persistent or relapsed smokers 6 months later. For CDM participants, our Tobacco Treatment Specialist will also provide telephone-based disease management during the hospitalization and after discharge, including supplemental support for pharmacotherapy that is consistent with their insurance plan and guidance on establishing effective discussions with their health care provider. The Tobacco Treatment Specialist will also fax treatment recommendations, prescription requests, and counseling suggestions to the healthcare provider. The proposed research will enhance our understanding of disease management for smoking cessation and, if successful, has the potential for immediate implementation in rural critical access hospitals. PUBLIC HEALTH RELEVANCE: Many hospitalized smokers do not receive effective smoking cessation treatment. In this follow-up to Kan Quit we will see if disease management for hospitalized smokers can increase use of effective pharmaco- therapy, improve communication with health care providers, and increase rates of smoking cessation.