Proactive Outreach for Smokers in VA Mental Health

退伍军人管理局心理健康部门积极主动为吸烟者提供服务

• 批准号: 8484925
• 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: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8484925
• 关键词: Abstinence; Address; Baseline Surveys; Behavior; Bipolar Disorder; Caring; Cause of Death; Cessation of life; Characteristics; Chronic; Cigarette; Clinical; Code; Communities; Computerized Medical Record; Control Groups; Counseling; Dependency; Diagnosis; Distress; Educational Technics; Enrollment; General Population; Health; Health Care Costs; Health Personnel; Health care facility; Healthcare; Healthcare Systems; Intervention; Letters; Medical; Medical Records; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Morbidity - disease rate; Nicotine; Participant; Patient Participation Rates; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Post-Traumatic Stress Disorders; Prevention program; Primary Health Care; Problem Solving; Provider; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Relapse; Reporting; Research; Research Infrastructure; Resources; Respondent; Schedule; Schizophrenia; Services; Smoke; Smoker; Smoking; Stress; Substance abuse problem; System; Telephone; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Treatment Protocols; United States; Veterans; Visit; Withholding Treatment; base; cost effective; evidence base; experience; follow-up; health practice; improved; meetings; novel; outreach; patient population; primary outcome; programs; smoking cessation; smoking prevalence; treatment as usual; treatment program; uptake

DESCRIPTION (provided by applicant): Proactive Outreach for Smokers in VA Mental Health Background: Tobacco use is the leading preventable cause of death in the United States and contributes up to 24% of all VA healthcare costs. Veterans enrolled in the VA healthcare system smoke substantially more than the general population, which is particularly true among Veterans diagnosed with mental illness. Patients with bipolar disorder or schizophrenia have the highest smoking rates (69% and 58-90%, respectively) followed by those with PTSD (45-63%) and depression (31-51%). Numerous barriers exist for tobacco cessation among mental health patients, including high nicotine dependency, low rates of follow through for referrals, and limited availability of tobacco treatment tailored to their needs. Rationale: Most medical care providers assess tobacco use and advise smokers to quit, but they have insufficient time to follow up with treatment, leading to low long-term quit rates. Mental health providers who often meet regularly with patients report that they find tobacco cessation outside the scope of their practice and neither assess tobacco use nor refer smokers for treatment. These practice patterns have been very difficult to change even with intensive methods and across various settings and provider types. Therefore, we propose to use the electronic medical record system to identify smokers receiving mental health care and proactively reach out to engage them in treatment in line with the following aims: Specific Aims: 1. Compare the reach and efficacy of a proactive outreach telephone-based tobacco cessation (PRO) program for patients seen in mental health to usual care (UC) advice and referral to local VA and community tobacco cessation resources. 2. Model longitudinal associations between baseline sociodemographic, medical and mental health characteristics and abstinence at 6 and 12 months in the PRO and UC conditions. Methods: We will use the electronic medical record to identify N=6,400 patients across 4 VA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past year and who have had a mental health visit in the past 6 months. We will send each patient an introductory letter and baseline survey. Respondents will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VA usual care. Intervention participants will receive proactive telephone counseling and cessation medications. We will assess tobacco use at 6 and 12 months from enrollment. The primary outcome is 30-day abstinence at the 12-month follow-up.

描述（由申请人提供）： 积极主动为退伍军人事务部吸烟者提供心理健康服务 背景：烟草使用是美国主要的可预防死亡原因，占退伍军人事务部所有医疗保健费用的 24%。参加退伍军人事务部医疗系统的退伍军人的吸烟量远远高于一般人群，这在被诊断患有精神疾病的退伍军人中尤其如此。双相情感障碍或精神分裂症患者的吸烟率最高（分别为 69% 和 58-90%），其次是 PTSD 患者（45-63%）和抑郁症患者（31-51%）。精神健康患者戒烟存在许多障碍，包括尼古丁依赖性高、转诊跟进率低以及针对其需求量身定制的烟草治疗的可用性有限。理由：大多数医疗保健提供者评估烟草使用情况并建议吸烟者戒烟，但他们没有足够的时间跟进治疗，导致 长期戒烟率低。经常与患者会面的心理健康服务提供者报告说，他们发现戒烟超出了他们的执业范围，既不评估烟草使用情况，也不推荐吸烟者接受治疗。即使使用强化方法并跨越各种设置和提供者类型，这些实践模式也很难改变。因此，我们建议使用电子病历系统来识别接受心理健康护理的吸烟者，并根据以下目标主动联系他们接受治疗： 具体目标： 1. 比较主动外展电话的覆盖范围和功效 -基于戒烟 (PRO) 计划，为接受心理健康检查的患者提供常规护理 (UC) 建议，并转介至当地 VA 和社区戒烟资源。 2. 对 PRO 和 UC 条件下基线社会人口统计、医疗和心理健康特征与 6 个月和 12 个月时的禁欲之间的纵向关联进行建模。方法：我们将使用电子病历来识别 4 个 VA 医疗机构的 N=6,400 名患者，这些患者拥有表明过去一年当前吸烟情况的临床提醒代码，并且在过去 6 个月内进行过心理健康就诊。我们将向每位患者发送一封介绍信和基线调查。受访者将以 1:1 的方式随机分配至干预组或对照组。对照参与者将接受 VA 常规护理。干预参与者将接受主动电话咨询和戒烟药物。我们将在入组后 6 个月和 12 个月评估烟草使用情况。主要结果是在 12 个月的随访中实现 30 天的禁欲。