Implementing tobacco use treatment guidelines in community health centers in Viet

在越南社区卫生中心实施烟草使用治疗指南

基本信息

批准号：
8631772
负责人：
Nam Truong Nguyen
金额：
$ 61.89万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8631772
关键词：
Abstinence Adherence Adoption Adult Air Area Asians Build-it Caring Characteristics Clinic Clinical Collaborations Community Health Community Health Centers Community Health Systems Counseling Country Effectiveness Epidemic Evaluation Evaluation Research Funding Future Goals Government Guidelines Health Health system Healthcare Systems Improve Access Income Institutes Intervention Knowledge Literature Medical Medical Care Team Methods Modeling Modification New York North Carolina Organizational Models Organizational Policy Patients Policies Population Preventive Preventive Health Services Provider Public Health Randomized Controlled Trials Readiness Reminder Systems Research Research Personnel Research Proposals Rural Science Services Smoke Smoker Smoking Specific qualifier value System Taxes Testing Tobacco Tobacco Dependence Tobacco use Training Treaty United States National Institutes of Health Universities Vietnam World Health Organization arm care systems clinical practice comparative effectiveness compare effectiveness contextual factors cost cost effective cost effectiveness evidence base evidence based guidelines experience follow-up health care delivery innovation member men mortality primary outcome public health relevance research to practice response secondary outcome smoking prevalence social theories tobacco control tobacco screening treatment strategy trial comparing

项目摘要

ABSTRACT Vietnam has a smoking prevalence that is the second highest among South East Asian countries (SEACs). With a population of approximately 90 million, Vietnam also has the second largest total number of adult smokers (over 16 million) in SEA. According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Tobacco use treatment, as defined by the U.S. Preventive Health Service Guideline (Guideline) on Treating Tobacco use and Dependence, is evidence-based and highly cost-effective. Yet, in the U.S. and globally, adoption of recommended care is suboptimal. The objective of this proposal is to fill the current research-to-practice gap by conducting a randomized controlled trial that compares the effectiveness and cost effectiveness of two practical and highly replicable strategies for implementing evidence-based guidelines for the treatment of tobacco use in public health clinics in Vietnam. The proposed implementation strategies draw on evidence- based approaches, and the WHO's recently released guidelines for implementing Article 14 of the Framework Convention on Tobacco Control (FCTC). The FCTC is an evidence-based treaty that was developed by the WHO in response to the globalization of the tobacco epidemic. Vietnam ratified the FCTC in 2004; however, they have not taken steps to implement Article 14 which specifies the need to integrate best practices for treating tobacco use and dependence into routine preventive care. The proposed implementation strategies also build on the growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We propose a two arm, cluster randomized controlled trial that will compare the effectiveness and cost effectiveness of two multi component strategies for implementing tobacco use treatment guidelines: 1) Technical assistance, training, plus clinical reminder system (TTC) vs. 2) TTC + referral to a community health worker (CHW). The primary outcome is provider adherence to tobacco use treatment guidelines (implementation effectiveness). The secondary outcome is six month biochemically verified smoking abstinence. We will conduct a formative evaluation prior to implementation to evaluation to assess current policies, systems of care and practice-level barriers and facilitators for tobacco use screening and treatment in public health clinics and inform modifications to the implementation strategies. Guided by an organizational model of innovation implementation, we will also examine organizational factors associated with effective implementation of provider adherence to tobacco use treatment guidelines. The study will be conducted in 26 public health clinics in two districts (rural and urban). The long-term goal of this research is to provide critical new knowledge to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based tobacco use treatment strategies globally and in the U.S.

抽象的越南的吸烟率在东南亚国家（SEAC）中位居第二。越南人口约 9000 万，成年人口总数位居第二东南亚吸烟者（超过 1600 万）。据世界卫生组织 (WHO) 称，大部分减少在不久的将来，通过帮助现有使用者戒烟，将可以降低烟草使用死亡率。烟草使用治疗，如美国预防保健服务指南（指南）中关于治疗烟草使用的定义和依赖性，是基于证据的并且具有很高的成本效益。然而，在美国和全球范围内，推荐的护理不是最理想的。该提案的目的是填补当前研究与实践之间的差距通过进行随机对照试验来比较两种方法的有效性和成本效益实施基于证据的治疗指南的实用且高度可复制的策略越南公共卫生诊所的烟草使用情况。拟议的实施战略借鉴了证据—— 的方法，以及世界卫生组织最近发布的实施框架第 14 条的指南烟草控制公约（FCTC）。 FCTC 是一项基于证据的条约，由世界卫生组织应对烟草流行的全球化。越南于2004年批准了《烟草控制框架公约》；然而，他们尚未采取措施实施第 14 条，该条规定需要整合最佳实践将烟草使用和依赖纳入常规预防护理。拟议的实施策略还以越来越多的文献为基础，这些文献支持将社区卫生工作者整合为有效的医疗保健团队成员改善获得预防服务的机会。我们提出了一个两臂集群随机对照试验将比较两种多成分的有效性和成本效益实施烟草使用治疗指南的策略： 1) 技术援助、培训以及临床提醒系统 (TTC) 与 2) TTC + 转介给社区卫生工作者 (CHW)。主要结果是提供者遵守烟草使用治疗指南（实施有效性）。二级结果是经过六个月生化验证的戒烟。我们将事先进行形成性评估从实施到评估，评估当前的政策、护理系统和实践层面的障碍公共卫生诊所烟草使用筛查和治疗的促进者，并通报对烟草使用筛查和治疗的修改实施策略。以创新实施的组织模式为指导，我们还将检查与有效实施提供者坚持吸烟相关的组织因素治疗指南。该研究将在两个地区（农村和城市）的 26 个公共卫生诊所进行。这项研究的长期目标是提供关键的新知识，以促进广泛的研究实施、传播和持续利用循证烟草使用治疗策略在全球和美国