A behavioral economic intervention to improve psychiatrist adherence to tobacco treatment guidelines

提高精神病医生对烟草治疗指南依从性的行为经济干预

• 批准号: 9765290
• 负责人: Erin Rogers
• 金额: $ 28.56万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9765290
• 关键词: Abstinence; Academic Detailing; Address; Adherence; American Psychiatric Association; Behavior; Bipolar Disorder; Clinical; Computerized Medical Record; Counseling; Data; Diagnosis; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Failure; Goals; HIV; Health; Health Personnel; Healthcare; Healthcare Systems; Hour; Human; Intervention; Interview; Literature; Mental Health; Mental disorders; Methods; New York; New York City; Organ Donations; Outpatients; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Population; Primary Care Physician; Primary Health Care; Provider; Psychiatrist; Psychiatry; Psychotic Disorders; Randomized; Research; Research Design; Sampling; Site; Smoke; Smoker; Smoking; Structure; Surveys; System; Testing; Time; Tobacco; Tobacco use; Training; Visit; Work; arm; barrier to care; behavioral economics; effectiveness trial; evidence base; follow-up; health care settings; high risk; improved; interest; mortality; patient population; patient screening; pilot trial; primary outcome; programs; routine screening; screening; secondary outcome; severe mental illness; tobacco screening; treatment guidelines

ABSTRACT Mental health patients are twice as likely to smoke as those without mental health diagnoses and suffer from increased rates of tobacco-related mortality. Effective cessation treatments exist for mental health patients, but smokers with mental health conditions encounter low rates of tobacco screening and treatment by psychiatrists. The literature and our prior work have identified multi-level barriers to treating tobacco in psychiatry, and traditional opt-in tobacco treatment systems (where providers and patients must initiate treatment) can perpetuate these barriers. Opt-out systems (where patients are automatically enrolled in treatment unless they decline) have dramatically improved health-related behavior in other settings. We aim to conduct the first evaluation of an opt-out approach to tobacco treatment in outpatient psychiatry. We propose a mixed-methods, two-arm cluster-randomized pilot trial that will: (1) Estimate the effects of an Opt-Out versus Opt-In Tobacco Treatment System on the proportion of mental health patients who are screened and treated for tobacco use by their psychiatrist; (2) Assess intervention fidelity, provider perceptions of the Opt-Out System, and barriers and facilitators to implementation of the Opt-Out System; and (3) Estimate the effects of an Opt-Out versus Opt-In Tobacco Treatment System on use of cessation treatment and abstinence among mental health patients who smoke. We will use a mixed-methods, two-arm cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists practicing at the VA New York Harbor Healthcare System (N = 20). Half of the psychiatrists will receive a reminder that encourages the psychiatrist to offer cessation medications and referral to cessation counseling to patients interested in quitting (Opt-In Reminder). The other half will receive a clinical reminder that includes a standing NRT order and a referral to cessation counseling that will automatically generate unless the provider actively opts-out (Opt-Out Reminder). Prior to implementation, psychiatrists in both arms will receive a one-hour training on tobacco treatment and academic detailing. We will use VA administrative data to calculate the study's primary outcomes: 1) the percent of patients screened for smoking, 2) the percent of smokers prescribed a cessation medication and 2) the percent of smokers referred to counseling. We will use training logs and post-visit surveys with a cluster sample of 400 patients to assess intervention fidelity. We will conduct semi-structured interviews with 12-14 psychiatrists asking about their perceptions of the intervention components. We will also analyze implementation observations and documents for implementation barriers and facilitators. At six months, we will survey the clustered 400-patient sample again to evaluate the study's secondary outcomes: 1) patient use of cessation treatment in the prior 6 months and 2) self-reported 7-day abstinence at 6 months.

抽象的 心理健康患者吸烟的可能性是没有心理健康诊断的患者的两倍，并且患有这些疾病 与烟草相关的死亡率增加。对于精神健康患者来说，存在有效的戒烟治疗，但是 有心理健康问题的吸烟者的烟草筛查和治疗率较低 精神科医生。文献和我们之前的工作已经确定了治疗烟草的多层次障碍 精神病学和传统的选择加入烟草治疗系统（提供者和患者必须启动 治疗）可以使这些障碍永久化。选择退出系统（患者自动加入 除非他们拒绝接受治疗）极大地改善了其他环境中与健康相关的行为。我们的目标是 对门诊精神病学中烟草治疗的选择退出方法进行首次评估。我们提出一个 混合方法、两臂整群随机试点试验将：(1) 评估选择退出与选择退出的效果 选择加入烟草治疗系统对接受筛查和治疗的精神健康患者的比例 其精神科医生使用烟草； (2) 评估干预忠诚度、提供者对选择退出的看法 系统以及实施选择退出系统的障碍和促进因素； (3) 估计影响 选择退出与选择加入烟草治疗系统关于戒烟治疗和戒烟的使用 吸烟的心理健康患者。我们将使用混合方法、双臂整群随机研究设计。 我们将为在纽约退伍军人管理局执业的门诊精神科医生实施烟草使用临床提醒 港口医疗系统（N = 20）。一半的精神科医生会收到鼓励他们 精神科医生为有兴趣戒烟的患者提供戒烟药物并转介戒烟咨询 （选择加入提醒）。另一半将收到临床提醒，其中包括长期 NRT 订单和 除非提供者主动选择退出（Opt-Out），否则将自动生成戒烟咨询转介 提醒）。实施前，双臂精神科医生将接受一小时的烟草培训 治疗和学术细节。我们将使用 VA 行政数据来计算该研究的主要 结果：1) 接受吸烟筛查的患者百分比，2) 接受戒烟处方的吸烟者百分比 药物治疗；2) 寻求咨询的吸烟者百分比。我们将使用培训日志和访问后 对 400 名患者进行整群抽样调查，以评估干预的保真度。我们将进行半结构化 采访 12-14 名精神科医生，询问他们对干预措施的看法。我们也会 分析实施观察和文件以找出实施障碍和促进因素。六点 几个月后，我们将再次调查聚集的 400 名患者样本，以评估研究的次要结果：1) 患者在前 6 个月内使用戒烟治疗，以及 2) 自我报告在 6 个月时进行了 7 天戒烟。