Disease Management for Smokers in Rural Primary Care

农村初级保健中吸烟者的疾病管理

• 批准号: 7255824
• 负责人: Edward F. Ellerbeck
• 金额: $ 58.76万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-09 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7255824
• 关键词: Abstinence; Address; Adherence; Affect; Bupropion; Case Manager; Chronic Disease; Cigarette; Clinic; Cost Effectiveness Analysis; Counseling; Disease; Disease Management; Effectiveness; Enrollment; Failure; Frequencies; Health; Health Personnel; Intervention; Kansas; Life; Mails; Modeling; Nicotine Dependence; Numbers; Outcome; Outcome Study; Participant; Patients; Personal Satisfaction; Pharmacotherapy; Physicians; Prevalence; Primary Health Care; Process; Professional counselor; Protocols documentation; Purpose; Randomized; Readiness; Recruitment Activity; Relapse; Rural; Rural Community; Smoker; Smoking; Staging; Techniques; Telephone; Testing; Upper arm; Week; base; cigarette smoking; comparison group; cost; cost effectiveness; day; improved; motivational enhancement therapy; nicotine replacement; prevent; programs; smoking cessation; success

DESCRIPTION (provided by applicant): Cigarette smoking and complications from cigarette smoking disproportionately affect people living in rural communities. Previous strategies to promote smoking cessation have largely been urban-based, involved short term interventions, enrolled smokers already motivated to quit, and been poorly integrated into primary care practice. Nicotine addiction may be better conceptualized as a chronic illness that might be most effectively addressed using newer models of chronic disease management. A disease management approach to smoking cessation would provide support for multiple quit attempts, treat smokers of all stages of readiness to quit, and coordinate cessation efforts with primary health care providers. The primary aim of this study is to assess the effectiveness of both high and low intensity, disease management programs for nicotine dependence. In this study, we will recruit 750 smokers from 20 rural, primary care clinics in Kansas. Subjects will be randomly assigned to one of three study arms, each providing 20 months of treatment: C (comparison group), LDM (low-intensity disease management) or HDM (high-intensity disease management). Participant's in-group C will receive health educational mailings and an offer for free nicotine replacement therapy (six weeks) or bupropion (seven weeks) every 6 months (months 0, 6, 12, and 18). Participants in LDM will receive the same interventions as C plus a low-intensity disease management program that includes a single telephone counseling session using motivational interviewing (MI)at months 0, 6, 12, and 18 to encourage a cessation attempt and also includes coordination of smoking assessments and pharmacotherapy with the patient's physician. HDM participants will receive C plus a high intensity disease management program that includes up to six telephone-based MI counseling sessions at months 0, 6, 12, and 18 to encourage a smoking cessation attempt and to prevent relapse after a quit attempt, as well as coordination of smoking assessments, quit attempts, and pharmacotherapy with the patient's physician. The primary outcome of the study is 7-day point prevalence abstinence from cigarettes at 2 years after enrollment. Secondary outcomes include: 1) number of quit attempts and 2) progress in stage of change. If successful, this intervention will provide a generalizable model for addressing nicotine dependence that could improve long-term management of smoking in primary care.

描述（由申请人提供）：吸烟和吸烟的并发症不成比例地影响居住在农村社区的人们。以前的促进戒烟的策略在很大程度上是基于城市的，涉及短期干预措施，招募吸烟者已经激励戒烟，并且融入了初级保健实践中。尼古丁成瘾可能会更好地概念化为一种慢性疾病，可以使用较新的慢性疾病管理模型来解决。戒烟的疾病管理方法将为多次戒烟尝试，治疗所有准备就绪阶段的吸烟者提供支持，并与初级卫生保健提供者进行戒烟。这项研究的主要目的是评估高强度和低强度，疾病管理计划对尼古丁依赖性的有效性。在这项研究中，我们将招募来自堪萨斯州20家农村初级保健诊所的750名吸烟者。受试者将被随机分配到三个研究组之一，每个人提供20个月的治疗：C（比较组），LDM（低强度疾病管理）或HDM（高强度疾病管理）。参与者的小组内C将收到健康教育邮件，并提供免费的尼古丁替代疗法（六周）或安非他酮（七个星期）（0、6、12和18个月）。 LDM的参与者将接受与C和低强度疾病管理计划相同的干预措施，其中包括在第0、6、12和18个月使用动机访谈（MI）进行一次电话咨询，以鼓励停止尝试，还包括对吸烟评估的协调以及与患者的医生进行药物治疗。 HDM参与者将收到C加上高强度疾病管理计划，其中包括在0、6、12和18月的最多六个基于电话的MI咨询课程，以鼓励戒烟尝试，并防止在戒烟尝试以及与患者医生的药物治疗，戒烟尝试，戒烟尝试以及药物治疗后的协调后进行复发。该研究的主要结果是入学后2年的香烟戒烟7天。次要结果包括：1）退出尝试的数量和2）变化阶段的进展。如果成功，此干预将为解决尼古丁依赖性提供可推广的模型，从而可以改善初级保健中吸烟的长期管理。