Examining the effect of a provider-delivered intervention among Medicaid smokers

检查提供者提供的干预措施对医疗补助吸烟者的效果

• 批准号: 7741889
• 负责人: Amy K Ferketich
• 金额: $ 17.67万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-13 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7741889
• 关键词: Address; Adopted; Adult; Advocate; Americas; Appalachian Region; Area; Attitude; Behavior; Behavior Control; Behavioral; Case Management; Clinical; Clinical Practice Guideline; Communities; Counseling; County; Data; Dependence; Diabetes Mellitus; Disadvantaged; Effectiveness of Interventions; Enrollment; Family; Feasibility Studies; Feedback; Focus Groups; Goals; Guidelines; Health Personnel; Health system; Hour; Hypertension; Income; Individual; Intervention; Interview; Managed Care Programs; Medicaid; Medical; Modeling; Nurses; Ohio; Outcome; Participant; Patients; Pharmacotherapy; Phase; Physicians; Physicians' Offices; Planning Theory; Play; Population; Prenatal care; Prevalence; Production; Professional counselor; Provider; Qualitative Research; Randomized; Randomized Controlled Clinical Trials; Recruitment Activity; Research; Role; Rural; Smoker; Smoking; Smoking Cessation Intervention; Staff Attitudes; System; Testing; Tobacco; Tobacco Use Cessation; Tobacco use; Training; Training and Education; United States; United States Public Health Service; Ursidae Family; Work; cost effectiveness; design; efficacy trial; experience; follow-up; intervention effect; medical appointment; novel; programs; public health relevance; smoking cessation; smoking prevalence; social; theories; trend; willingness

DESCRIPTION (provided by applicant): The objectives of this project are to test the feasibility and obtain preliminary efficacy data for a physician office-delivered smoking cessation intervention targeting smokers enrolled in Medicaid Managed Care Programs (MMCPs) in Ohio Appalachia. The smoking prevalence is 48% among Medicaid enrollees in Appalachia, which is more than twice as high as the state estimate (1). Two MMCPs serving the Ohio Appalachian region have agreed to work with us by supplying a list of providers and support for the project. The specific aims of this R21 proposal are to perform a qualitative study with physicians, office staff, and MMCP smokers to better understand: 1) physician and office staff attitudes, norms, and perceived behavioral control; and 2) how a scientifically-valid intervention should be incorporated into an MMCP office and delivered to patients. 2. To test the feasibility of a physician office-delivered intervention in promoting: 1) quit attempts and use of cessation pharmacotherapy among Appalachian MMCP enrollees; 2) delivery of the 5A's by the MMCP physician offices; and 3) changes in physicians' attitudes and perceived behavioral control. 3. Exploratory: To examine the cost-effectiveness of delivering the intervention to MMCP enrollees. A two-phase design will be used for this study. In Phase I, qualitative research will be used to gain an understanding of the issues involved with implementing a comprehensive tobacco cessation program in MMCP physician offices. Physicians, their staff, and MMCP smokers will be recruited and asked to engage in qualitative interviews or focus groups. Phase II will consist of a pilot and feasibility test of the intervention targeting physician offices. The overarching goal of the intervention will be to promote systems-level changes in MMCP physician offices to promote smoking cessation among Medicaid enrollees. The intervention will include: 1) implementation of a tobacco-user identification system; 2) education and training of physicians; 3) periodic feedback to physicians; and 4) recruitment and training of an "office champion" to promote compliance with the intervention. For Phase II, a group-randomized trial will be used to pilot test the intervention in 8 randomly selected physician offices in Athens County, Ohio (4 offices will be randomized to the intervention and 4 to the control condition). From each physician office, a total of 30 MMCP smokers will be recruited as then come in for a medical appointment. Outcomes, which are quit attempts for 24 hours and use of pharmacotherapy, will be assessed among these participants at 3 months post-enrollment. PUBLIC HEALTH RELEVANCE: Public Health Relevance In Ohio Appalachia, 16% of adults are enrolled in the Medicaid program, and half of these individuals are current smokers. The research will provide important information to assist in reducing smoking among Medicaid enrollees in Ohio Appalachia. These findings may be generalizable to other rural and Appalachian communities in the United States.

描述（由申请人提供）：该项目的目标是测试医生办公室针对俄亥俄州阿巴拉契亚州参加医疗补助管理护理计划 (MMCP) 的吸烟者提供的戒烟干预措施的可行性并获得初步疗效数据。阿巴拉契亚地区医疗补助参与者的吸烟率为 48%，是州估计值的两倍多 (1)。服务于俄亥俄州阿巴拉契亚地区的两个 MMCP 已同意与我们合作，提供供应商名单并为该项目提供支持。该 R21 提案的具体目标是对医生、办公室工作人员和 MMCP 吸烟者进行定性研究，以更好地了解：1) 医生和办公室工作人员的态度、规范和感知行为控制； 2) 如何将科学有效的干预措施纳入 MMCP 办公室并交付给患者。 2. 测试医生办公室提供的干预措施在促进以下方面的可行性： 1) 在阿巴拉契亚 MMCP 参与者中戒烟尝试和使用戒断药物治疗； 2) 由 MMCP 医师办公室提供 5A； 3) 医生态度和感知行为控制的变化。 3. 探索性：检查向 MMCP 参与者提供干预措施的成本效益。 本研究将采用两阶段设计。在第一阶段，将使用定性研究来了解在 MMCP 医生办公室实施全面戒烟计划所涉及的问题。将招募医生、他们的工作人员和 MMCP 吸烟者，并要求他们进行定性访谈或焦点小组。第二阶段将包括针对医生办公室的干预措施的试点和可行性测试。干预的总体目标是促进 MMCP 医生办公室的系统级变革，以促进医疗补助参与者戒烟。干预措施将包括： 1) 实施烟草使用者识别系统； 2）医师的教育和培训； 3）定期向医生反馈； 4) 招募和培训“办公室冠军”以促进干预措施的遵守。对于第二阶段，将使用分组随机试验在俄亥俄州雅典县随机选择的 8 个医生办公室进行干预试验（4 个办公室将被随机分配到干预组，4 个办公室将被随机分配到对照条件）。每个医生办公室将招募总共 30 名 MMCP 吸烟者，然后前来进行医疗预约。入组后 3 个月将对这些参与者的结果进行评估，包括尝试 24 小时戒烟和使用药物治疗。 公共健康相关性：公共健康相关性 在俄亥俄州阿巴拉契亚地区，16% 的成年人参加了医疗补助计划，其中一半是目前的吸烟者。该研究将提供重要信息，以帮助减少俄亥俄州阿巴拉契亚地区医疗补助参与者的吸烟率。这些发现可能适用于美国其他农村和阿巴拉契亚社区。