Centralized Disease Management for Rural Hospitalized Smokers

农村住院吸烟者疾病集中管理

基本信息

批准号：
8212309
负责人：
Edward F. Ellerbeck
金额：
$ 55.82万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-07-09 至 2014-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8212309
关键词：
Abstinence Attention Caring Cigarette Communication Communities Cotinine Counseling Disease Management Effectiveness Elements Foundations Goals Health Health Personnel Hospitalization Hospitals Human Resources Inpatients Insurance Insurance Coverage Kansas Lead Link Mediating Medical Care Team Modeling Outcome Participant Patients Pharmaceutical Preparations Pharmacotherapy Population Positioning Attribute Prevalence Randomized Readiness Recommendation Recruitment Activity Relapse Research Resources Rural Rural Community Rural Health Rural Hospitals Salivary Screening procedure Smoke Smoker Smoking Specialist Staging Suggestion Telefacsimile Telephone Testing Time Tobacco Tobacco use Withholding Treatment Work arm base chronic care model cost effectiveness critical access hospital design disease management study effective therapy expectation experience follow-up high risk improved innovation multidisciplinary primary outcome programs smoking cessation

项目摘要

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.

描述（由申请人提供）：住院吸烟者因继续吸烟而出现并发症的风险很高。尽管全国的注意力都集中在住院患者的戒烟上，但乡村医院却无法实施有效戒烟计划的全部内容。在 Kan Quit 的竞争性更新中，我们经验丰富的多学科团队将建立在农村社区戒烟研究的坚实基础上。 Kan Quit 针对处于准备戒烟的各个阶段的吸烟者，证明将免费药物治疗与药物治疗管理相结合的疾病管理可以使 78% 的吸烟者接受有效治疗。不幸的是，免费的戒烟药物疗法并非普遍可用。各州的戒烟计划供应有限，选择也有限；尽管药物治疗的处方覆盖范围越来越广，但其利用不足，特别是在住院吸烟者的高危人群中。我们修订后的疾病管理计划以慢性护理模式为基础，旨在提供咨询和疾病管理，同时提高药物治疗的利用率并加强医疗保健提供者的支持。与 Kan Quit 相比，我们修订后的疾病管理计划将利用社区已有的药物治疗资源。我们的具体目标是 1) 评估集中疾病管理 (CDM) 对住院农村吸烟者戒烟的有效性； 2) 测试 CDM 对药物治疗利用的影响并与医疗保健提供者进行讨论； 3）阐明这些元素的利用如何调节CDM对戒烟的影响； 4) 检查 CDM 戒烟的边际成本效益。这项研究将在堪萨斯州 30 家农村危重医院进行。主要结局是通过唾液可替宁证实的 7 天点戒断率。住院的农村吸烟者将被随机分配接受 CDM 或单独接受咨询 (C)（每组 303 名）。所有参与者都将在第 3 天、第 7 天、第 21 天和第 90 天接受院内电话咨询和电话随访。6 个月后，将进行第二次努力，以重新吸引持续或复吸的吸烟者。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，包括符合其保险计划的药物治疗补充支持以及与医疗保健提供者建立有效讨论的指导。烟草治疗专家还将治疗建议、处方请求和咨询建议传真给医疗保健提供者。拟议的研究将增强我们对戒烟疾病管理的理解，如果成功，有可能立即在农村危重医院实施。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 Quit 的后续行动中，我们将了解住院吸烟者的疾病管理是否可以增加有效药物治疗的使用，改善与医疗保健提供者的沟通，并提高戒烟率。