Leveraging Community Pharmacists to Optimize Smoking Cessation Services for Rural Smokers in Appalachia

利用社区药剂师优化阿巴拉契亚农村吸烟者的戒烟服务

基本信息

批准号：
10551936
负责人：
Melissa Ashley Little
金额：
$ 101.74万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-08 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10551936
关键词：
Abstinence Address Adherence Adoption Affect Appalachian Region Area Biochemical Chronic Disease Clinical Code Communities Community Pharmacy Counseling Diabetes Mellitus Documentation Effectiveness Face Financial compensation Focus Groups Foundations Future Health Health Promotion Hypertension Insurance Carriers Intervention Maintenance Malignant Neoplasms Medication Management Methods Modeling National Cancer Institute Outcome Participant Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Policies Population Prevalence Primary Health Care Randomized Reach Effectiveness Adoption Implementation and Maintenance Reporting Research Resources Risk Factors Rural Rural Appalachia Rural Population Services Smoker Smoking Smoking Cessation Intervention Statutes and Laws Surveys Time Tobacco Tobacco Use Cessation Tobacco use Tobacco-Related Carcinoma Update base cigarette smoking cost effectiveness evaluation evidence base experimental study follow-up high risk implementation evaluation implementation fidelity medically underserved medication compliance nicotine gum nicotine replacement parity post implementation primary care setting primary outcome programs quitline recruit relative cost rural area smoking cessation smoking-related cancer text messaging intervention underserved area underserved rural area urban area

项目摘要

Rural Appalachian populations have the highest rates of cigarette smoking in the U.S. and are disproportionately affected by tobacco-related cancers. Publicly available smoking cessation resources (e.g., state quitlines, text-based interventions, nicotine replacement therapy [NRT]) are under-utilized by rural Appalachian smokers. Furthermore, rural Appalachia is medically underserved; thus, smoking cessation services within primary care settings face additional barriers. Community pharmacists, with their centralized placement in local communities and clinical expertise, are ideally situated to build capacity in underserved areas such as rural Appalachia to enhance existing smoking cessation resources for smokers. Research on pharmacist-delivered smoking cessation interventions is limited and does not provide for documentation and billing to compensate pharmacists for their time spent counseling patients. Medication Therapy Management (MTM), a pharmacist-delivered medication adherence approach that allows pharmacists to receive compensation for providing medication expertise, could be leveraged to promote smoking cessation. To address this gap, we developed an MTM intervention, QuitAid, to increase smoking cessation among rural smokers. QuitAid was based on a medication adherence intervention shown to be efficacious in a quitline setting. The purpose of the proposed study is to use a pragmatic approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to identify the essential components of an effective smoking cessation program that can easily integrate within community pharmacies in underserved rural areas. Smokers (n=768) recruited through 14 community pharmacies in rural Appalachia will be randomized in a 25 full factorial experiment to the following five treatments: (1) QuitAid (Yes vs. No), (2) tobacco quitline (Yes vs. No), (3) SmokefreeTXT (Yes vs. No), (4) Combination NRT Gum + NRT Patch (vs. NRT patch alone), and/or (5) 8 weeks of NRT (vs. standard 4 weeks). The primary outcome is biochemically- confirmed point prevalence abstinence at the 6-month follow-up. We will also assess implementation, including relative cost, as well as facilitators and barriers of reach, adoption, and maintenance of QuitAid and standard, evidence-based tobacco treatments through an ask-advise-connect method in community pharmacies. Our main hypothesis is that a smoking cessation MTM will increase smoking cessation and enhance reach and adherence to publicly available smoking cessation resources in medically underserved rural areas. The proposed study will: (1) provide foundational evidence for leveraging community pharmacists in underserved and rural areas to promote utilization of existing evidence-based tobacco cessation resources through enhanced MTM support, (2) inform updated national guidance on treating rural smokers, and (3) aid state legislation efforts related to pharmacy smoking cessation programs and policies. Ultimately, this research will inform strategies for smoking cessation in rural areas, such that cancer rates achieve parity with urban areas.

阿巴拉契亚农村人口的吸烟率是美国最高的，并且受烟草相关癌症的影响尤为严重。公开可用的戒烟资源（例如，农村地区未充分利用州戒烟热线、基于文本的干预措施、尼古丁替代疗法 [NRT]）阿巴拉契亚吸烟者。此外，阿巴拉契亚农村地区的医疗服务不足；因此，戒烟初级保健机构内的服务面临着额外的障碍。社区药剂师，用他们的集中安置在当地社区和临床专业知识，是能力建设的理想场所在阿巴拉契亚农村等服务不足的地区，加强现有的戒烟资源吸烟者。关于药剂师提供的戒烟干预措施的研究有限，并且没有提供用于补偿药剂师为患者提供咨询所花费的时间的文件和账单。药物治疗管理 (MTM)，一种由药剂师提供的药物依从性方法，允许药剂师获得因提供药物专业知识而获得的报酬，可以用来促进戒烟。为了解决这一差距，我们开发了 MTM 干预措施 QuitAid，以提高农村地区的戒烟率吸烟者。 QuitAid 基于药物依从性干预，该干预在戒烟热线中被证明是有效的环境。拟议研究的目的是采用务实的方法，以 Reach 为指导，有效性、采用、实施和维护 (RE-AIM) 框架，以确定基本要素有效戒烟计划的组成部分，可以轻松整合到社区药房中在服务欠缺的农村地区。通过阿巴拉契亚农村地区的 14 家社区药房招募吸烟者 (n=768) 将在 25 个全析因实验中随机分配以下五种治疗方法：(1) QuitAid（是与否），(2) 戒烟热线（是与否），(3) SmokefreeTXT（是与否），(4) NRT 口香糖 + NRT 贴片组合（与 NRT 贴片）单独使用 NRT 贴剂），和/或 (5) 8 周 NRT（相对于标准 4 周）。主要结果是生化- 在 6 个月的随访中确认了点戒断率。我们还将评估实施情况，包括相对成本，以及 QuitAid 和标准的影响、采用和维护的促进因素和障碍，在社区药房通过询问-建议-连接方法进行循证烟草治疗。我们的主要假设是戒烟 MTM 将提高戒烟率并提高戒烟范围和效果在医疗服务不足的农村地区坚持使用公开的戒烟资源。这拟议的研究将：(1) 为在服务不足的地区利用社区药剂师提供基础证据和农村地区通过以下方式促进现有循证戒烟资源的利用：加强 MTM 支持，(2) 提供有关治疗农村吸烟者的最新国家指南，以及 (3) 援助国家与药房戒烟计划和政策相关的立法工作。最终，这项研究将为农村地区的戒烟策略提供信息，使癌症发病率与城市地区持平。