Reducing Tobacco Use Disparities Among Adults in Safety Net Community Health Centers

减少安全网社区健康中心成年人的烟草使用差异

• 批准号: 9044463
• 负责人: Alicia K Matthews
• 金额: $ 3.37万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-24 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9044463
• 关键词: Abstinence; Address; Adult; Advanced Malignant Neoplasm; Behavioral; Caring; Centers for Population Health; Chicago; Cigarette; Clinic; Clinic Visits; Clinical; Community Health Centers; Community Services; Counseling; Data; Disease; Effectiveness; Electronic Health Record; Electronics; Elements; Ethnic Origin; Evaluation; Exercise; Federally Qualified Health Center; Feedback; Future; Goals; Health Care Visit; Healthcare; Healthcare Systems; Illinois; Intervention; Letters; Link; Low income; Outcome Study; Participant; Patients; Population; Prevalence; Primary Health Care; Provider; Race; Randomized Controlled Trials; Readiness; Self Determination; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; System; Telephone; Text; Time; Tobacco; Tobacco use; Treatment outcome; Underserved Population; United States; Visit; Voice; Withholding Treatment; base; design; effective therapy; follow-up; free behavior; health equity; health literacy; innovation; interest; intervention effect; literacy; nicotine replacement; outreach; person centered; population health; public health relevance; quitline; reduce tobacco use; routine care; safety net; smoking cessation; theories; treatment as usual; trial comparing

An estimated 26 million smokers still receive no treatment for their smoking during their primary care visits. Given the persistent clinical system, provider, and patient barriers to addressing smoking, especially among poor populations, an EHR-automated population health management approach that links a healthcare system with community services both clinically and electronically to engage all smokers may increase access to effective treatment. Increased access is especially significant for low-income smokers who are underserved and carry a disproportionate burden of tobacco-related disease. While 90% of smokers are not ready to quit, many are interested in cutting down, and smoking reduction increases the likelihood of future quit attempts and smoking cessation. Based on self-determination theory, person-centered population outreach that targets low- income smokers and offers them the choice to either quit or cut down as a first step towards cessation may increase their engagement in and utilization of treatment and likelihood of achieving abstinence. This 2-group randomized controlled trial will evaluate the effectiveness of a person-centered population health management intervention for smoking cessation in low-income smokers. Participants will be 530 diverse, low-income smokers of a large Federally Qualified Health Center (FQHC) in Chicago identified using its electronic health record (EHR) system. Automated via the EHR system, participants will be mailed a letter on behalf of their providers that encourages smoking cessation or smoking reduction as a first step to cessation if not ready to set a quit date (Choose to Change; N=265). The letter will be paired with two automated text/voices messages three days apart that are designed to reinforce the central messaging of the letter (“Choose to change and make your own goal”). Two weeks after letter mailing, participants will receive a call from the Illinois Tobacco Quitline and be offered free person-centered behavioral counseling and free nicotine replacement therapy (NRT; patch, gum, or lozenge). Treatment will continue as either accepted or initiated by participants for 26 weeks. Treatment outcomes will be transmitted directly from the Quitline server to the EHR system. Choose to Change will be compared with Usual Care (N=265), in which a referral for proactive Quitline treatment is made during a clinic visit. The primary study outcomes will be treatment engagement (initial counseling call completed) at 6 weeks, utilization (one or more additional counseling calls completed) at 12 weeks, and smoking cessation (bioverified 7-day point-prevalence abstinence) at 26 weeks. An exploratory study aim will be to examine moderators of intervention effects. We hypothesize that Choose to Change will increase the proportion of smokers who engage in and utilize treatment and who achieve cessation, as compared with Usual Care. An EHR-automated, person-centered, population health management intervention that is informed by both theory and patient feedback and targeted to low-income smokers could reduce critical disparities in treatment access, utilization, and cessation. If determined to be effective, the Choose to Change intervention could be disseminated to FQHCs and state quitlines throughout the United States.

据估计，有 2600 万吸烟者在初级保健就诊期间仍然没有得到针对吸烟的治疗。 鉴于临床系统、提供者和患者在解决吸烟问题上持续存在障碍，特别是在 贫困人口，一种连接医疗保健系统的 EHR 自动化人口健康管理方法 通过临床和电子社区服务来吸引所有吸烟者可能会增加获得 增加有效治疗的机会对于服务不足的低收入吸烟者尤其重要。 尽管 90% 的吸烟者还没有准备好戒烟， 许多人对减少吸烟感兴趣，减少吸烟会增加未来尝试戒烟的可能性， 基于自我决定理论，以人为本的人口推广活动，目标是低烟民。 收入吸烟者，并为他们提供戒烟或减少吸烟量的选择，作为戒烟的第一步可能 增加他们对治疗的参与和利用以及实现戒断的可能性这两组。 随机对照试验将评估以人为本的人口健康管理的有效性 低收入吸烟者戒烟干预措施的参与者将是 530 名不同的低收入人群。 芝加哥一家大型联邦合格健康中心 (FQHC) 的吸烟者使用其电子健康进行识别 通过 EHR 系统自动化，参与者将收到代表他们的信件。 如果尚未准备好，鼓励戒烟或减少吸烟作为戒烟第一步的提供者 设置戒烟日期（选择更改；N=265）。该信件将与两个自动文本/语音配对。 相隔三天的信息旨在强化这封信的中心信息（“选择 信件邮寄两周后，参与者将接到来自 伊利诺伊州烟草戒烟热线，并提供免费的以人为本的行为咨询和免费的尼古丁 替代疗法（NRT；贴片、口香糖或含片）将继续按照接受或启动的方式进行治疗。 参与者为期 26 周的治疗结果将直接从戒烟热线服务器传输到 EHR。 选择改变系统将与通常护理（N=265）进行比较，其中主动转介。 戒烟热线治疗是在门诊就诊时进行的，主要研究结果是治疗参与度。 （完成初始咨询电话）在 6 周时，利用率（完成一次或多次额外咨询电话）在 12 周时戒烟（经生物验证的 7 天点流行戒烟） 探索性。 研究的目的是检查干预效果的调节因素，我们致力于选择改变。 增加参与和利用治疗并实现戒烟的吸烟者比例，如 与普通护理相比，以 EHR 为中心的自动化、以人为本的人口健康管理干预措施。 根据理论和患者反馈，针对低收入吸烟者，可以减少关键吸烟者的吸烟率 治疗获得、利用和停止方面的差异 如果确定有效，则选择改变。 干预措施可以传播到美国各地的 FQHC 和州戒烟热线。