Comparing an opt-out to an opt-in approach for smoking cessation in VA primary care clinics

退伍军人事务部初级保健诊所选择退出与选择加入戒烟方法的比较

• 批准号: 10186542
• 负责人: STEVEN FU
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186542
• 关键词: Abstinence; Affect; Ambulatory Care; Behavior Therapy; Behavioral; Belief; Caring; Cause of Death; Characteristics; Clinic; Costs and Benefits; Counseling; Diabetes Mellitus; Enrollment; Health Personnel; Health care facility; Health system; Healthcare; Healthcare Systems; Human; Hypertension; Intervention; Methods; Organ Donations; Patients; Pharmaceutical Preparations; Population; Pregnant Women; Primary Health Care; Provider; Randomized; Recommendation; Reporting; Research; Sexually Transmitted Diseases; Site; Smoker; Smoking; Structure; System; Telephone; Testing; Text Messaging; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; base; behavioral economics; behavioral study; compare effectiveness; cost; cost effective; effectiveness implementation study; evidence base; population based; pressure; programs; quitline; recruit; research study; satisfaction; screening; smoking cessation; telephone coaching

ABSTRACT Smoking is the leading preventable cause of death in the US, and health care systems are able to reach a large number of smokers and effectively engage them into evidence based tobacco treatment. Effective cessation approaches include medications and behavioral treatment (including face-to-face counseling, telephone counseling and text messaging). While delivery of smoking cessation medications has increased, it has proven more difficult to increase the delivery of behavioral treatments. Within primary care, health care providers are effective at counseling smokers to quit, yet few providers actually deliver longitudinal counseling due to time pressures and competing priorities. The two main evidence-based approaches available in the U.S. for behavioral tobacco dependence treatment include Quitlines (to deliver telephone counseling) and text messaging programs. Tobacco Quitlines are effective and our prior studies have explored different approaches to increasing use of Quitlines, yet many questions remain about how best to do this within health care systems. Similarly, text messaging is effective at helping smokers to quit, but is rarely used in health care. While 11% of smokers reported having used a quit smoking program that involves text messaging, no studies to date have examined health care-based approaches to increase engagement in text messaging programs, such as VA’s SmokefreeVET. Our prior research shows that nearly all smokers are capable of receiving text messages and most feel that it would help them to quit. National mandates call for health care systems to refer all smokers to treatment, yet there is little guidance on how to achieve this objective. Studies from behavioral economics and other fields suggest that how the referral is framed is extremely important. Systems typically use an opt-in approach where the default is “no treatment”, unlike conditions such as diabetes or hypertension where we treat people unless they opt-out of treatment. An opt-out approach has proven much more effective in other settings, such as organ donation, screening for sexually transmitted diseases and recruitment for research studies. Aside from an uncontrolled UK study among pregnant women, no studies have tested an opt-out approach for smokers in ambulatory care. We propose a Type I hybrid effectiveness/implementation study to evaluate two population-based approaches for increasing use of Quitlines and text messaging at two VA sites. Specifically, we will test the default bias, examining whether an opt-out approach to referral is more effective than an opt-in approach. We will randomly assign teams to either an opt-out or opt-in approach to referring smokers to treatment. In the opt- out approach, the default is that everyone is referred to treatment unless they actively choose not to be. In the opt-in approach, people are offered treatment but must actively choose to enroll in it. Our specific aims are: (1) To compare the effectiveness of an opt-out approach to an opt-in approach at helping patients quit smoking in primary care; (2) To compare the costs and benefits of an opt-out approach to an opt-in approach to smoking cessation in primary care.; and (3) To evaluate patient and staff factors affecting implementation of the opt-out and opt-in interventions in primary care. If effective, this approach would provide a simple, easily scalable method for increasing engagement in behavioral treatment and for boosting long-term abstinence rates.

抽象的 吸烟是美国主要的可预防死亡原因，医疗保健系统能够 接触大量吸烟者并有效地让他们参与基于证据的烟草治疗。 有效的戒烟方法包括药物治疗和行为治疗（包括面对面戒烟） 咨询、电话咨询和短信）。 事实证明，在初级保健中增加行为治疗的提供变得更加困难。 医疗保健提供者能够有效地建议吸烟者戒烟，但很少有提供者真正提供纵向戒烟服务。 由于时间压力和相互竞争的优先事项，这两种主要的基于证据的方法。 在美国，可用于行为烟草依赖治疗的方法包括戒烟热线（提供电话 咨询）和短信戒烟计划是有效的，我们之前的研究已经探索过。 增加戒烟热线的使用有不同的方法，但关于如何在内部最好地做到这一点仍然存在许多问题 同样，短信可以有效帮助吸烟者戒烟，但很少用于医疗保健系统。 虽然 11% 的吸烟者表示曾使用过涉及短信的戒烟计划， 迄今为止，还没有研究探讨基于医疗保健的方法来增加短信参与度 计划，例如 VA 的 SmokefreeVET。我们之前的研究表明，几乎所有吸烟者都有能力。 收到短信后，大多数人认为这会帮助他们戒烟，因为国家强制要求提供医疗保健。 系统将所有吸烟者转介至治疗，但关于如何实现这一目标的研究却很少。 行为经济学和其他领域的研究表明，如何设计推荐是极其重要的。 系统通常使用选择加入的方法，默认为“不治疗”，这与以下情况不同： 除非他们选择退出治疗，否则我们会治疗糖尿病或高血压。 事实证明在其他环境中更为有效，例如器官捐赠、性传播疾病筛查 除了一项针对孕妇的不受控制的英国研究之外， 没有研究测试过门诊护理中吸烟者的选择退出方法。 我们提出了一项 I 型混合有效性/实施研究来评估两种基于人群的研究 具体而言，我们将测试在两个 VA 站点增加戒烟热线和短信使用的方法。 默认偏差，检查选择退出的推荐方法是否比选择加入的方法更有效。 将分配团队以随机选择退出或选择加入的方式将吸烟者转介至治疗。 默认情况下，每个人都会被转介治疗，除非他们主动选择不接受治疗。 选择加入方法，人们可以获得治疗，但必须主动选择参加。 我们的具体目标是： (1) 比较选择退出方法与选择加入方法的有效性 帮助初级保健患者戒烟；(2) 比较选择退出方法的成本和收益； 在初级保健中采用选择加入的戒烟方法；以及 (3) 评估影响患者和工作人员的因素 在初级保健中实施选择退出和选择加入干预措施。 如果有效，这种方法将提供一种简单、易于扩展的方法来提高参与度 行为治疗和提高长期戒烟率。