Implementing Effective Smoking Cessation Pharmacotherapy for Hospitalized Smokers with Cardiopulmonary Disease

对患有心肺疾病的住院吸烟者实施有效的戒烟药物治疗

基本信息

批准号：
10588125
负责人：
Quinn Russell Pack
金额：
$ 67.23万
依托单位：
BAYSTATE MEDICAL CENTER, INC.
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-15 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10588125
关键词：
Address Adherence Administrator American Behavioral Cardiopulmonary Cause of Death Cellular Phone Cessation of life Combination Medication Cost Savings Counseling Coupled Data Economics Effectiveness Failure Financial Hardship Financial Support Future General Hospitals Goals Grant Guidelines Health Expenditures Hospital Administrators Hospitalization Hospitals Hybrids Individual Inhalators Inpatients Insurance Intervention Interview Knowledge Lead Length of Stay Measures Mediating Medicine Meta-Analysis Modeling Motivation Nicotinic Agents Nurse Practitioners Outpatients Patients Pharmaceutical Preparations Pharmacotherapy Physicians Policies Proctor framework Professional counselor Program Sustainability Pulmonary Heart Disease Qualitative Methods Randomized Recommendation Safety Services Smoker Smoking Smoking Cessation Intervention System Technology Testing Text Messaging Time Tobacco Tobacco use Training United States Wages acceptability and feasibility cost cost effective cost effectiveness discount economic evaluation economic value effectiveness evaluation effectiveness-implementation randomized trial effectiveness/implementation trial experience follow-up health economics implementation outcomes implementation science implementation strategy improved low socioeconomic status medication compliance member multidisciplinary nicotine patch premature quitline randomized trial skills smoking cessation smoking relapse success symptom management tertiary care theories treatment and outcome treatment as usual treatment program uptake varenicline virtual

项目摘要

PROJECT SUMMARY Tobacco use remains the leading cause of death in the United States and contributes to more than 7 million hospitalizations annually. Hospitalization offers a critical window for intervention: hospital policies prohibit smoking, patients are highly motivated to quit, and societal guidelines recommend that clinicians should counsel patients and prescribe smoking cessation pharmacotherapy (SCP) to virtually all smokers. Nevertheless, only 22% of patients are ever prescribed SCP while hospitalized and only 1% of patients are prescribed guideline-concordant SCP. This failure ultimately contributes to a 70-80% smoking relapse rate, most of which occurs within a few days of hospital discharge – well before outpatient follow-up can occur. If we are to capitalize on the opportunity that hospitalization provides to maximize smoking cessation treatment and outcomes, new strategies are needed to overcome the low uptake of guideline-concordant SCP by physicians and patients. To address this problem, we propose to deploy a nurse practitioner-led, hospital- based tobacco treatment team to: 1) prescribe individually tailored and guideline-concordant SCP; 2) counsel and motivate patients to use SCP properly; and 3) and manage a mobile phone-based text-messaging system to keep patients motivated and adherent to SCP. Our preliminary data suggest that such an approach is feasible and acceptable to patients, physicians, and hospital administrators. In Aim 1, we will perform a parallel-group implementation-effectiveness randomized trial among 424 hospitalized smokers with a cardiopulmonary disease in a large tertiary hospital. We will compare rates of SCP use and smoking cessation between patients who received the intervention and those who did not. In Aim 2, we will measure the economic value of the intervention from both a hospital and payer perspective to better inform hospital and insurance policies and sustainability. In Aim 3, we will perform qualitative interviews with patients, physicians, staff members, and hospital administrators to evaluate the acceptability and sustainability of our strategies. We hypothesize that our intervention will: improve guideline-concordant SCP use; increase 6- month smoking cessation rates; be acceptable to patients, clinicians, and administrators; and be cost-effective and sustainable. Our multi-disciplinary team has broad experience in cardiopulmonary medicine, tobacco treatment, implementation science, medication adherence, qualitative methods, health economics, and text message technology. At the conclusion of this grant, our team will develop a detailed, evidence-informed implementation guide for a hospital-based tobacco treatment team. Ultimately, we anticipate the knowledge gained from this study will facilitate widespread and effective hospital-based tobacco treatment so that more patients lead lives free from tobacco and cardiopulmonary disease.

项目概要烟草使用仍然是美国的首要死因，导致超过 700 万人死亡每年住院治疗提供了一个关键的干预窗口：医院禁止政策。吸烟、患者戒烟的积极性很高，以及指南应制定的社会建议向患者提供咨询并向几乎所有吸烟者开出戒烟药物疗法 (SCP)。然而，只有 22% 的患者在住院期间服用过 SCP 处方，并且只有 1% 的患者接受过 SCP 处方治疗。这种失败最终导致 70-80% 的吸烟复吸率，其中大部分发生在出院后几天内——远远早于门诊随访。如果我们要利用住院治疗提供的机会最大限度地戒烟治疗和结果，需要新的策略来克服符合指南的 SCP 的低吸收率为了解决这个问题，我们建议部署一个由执业护士领导的医院- 烟草治疗团队： 1) 开具个性化且符合指南的 SCP 2) 咨询；并激励患者正确使用 SCP；以及 3) 并管理基于手机的短信系统保持患者积极性并遵守 SCP。我们的初步数据表明，这种方法是有效的。患者、医生和医院管理人员可行且可接受。在目标 1 中，我们将在 424 名参与者中进行平行组实施效果随机试验我们将比较大型三级医院因心肺疾病住院的吸烟者的 SCP 发生率。在目标 2 中，接受干预的患者和未接受干预的患者之间的使用和戒烟情况。我们将从医院和付款人的角度衡量干预措施的经济价值，以便更好地评估干预措施的经济价值。为医院和保险政策以及可持续性提供信息在目标 3 中，我们将进行定性访谈。患者、医生、工作人员和医院管理人员评估可接受性和可持续性我们的策略是，我们的干预将：改善与指南一致的 SCP 使用；月戒烟率；患者、人群和管理人员可以接受并且具有成本效益；和可持续的。我们的多学科团队在心肺医学、烟草治疗、实施科学、药物依从性、定性方法、健康经济学和短信在这笔资助结束时，我们的团队将开发一个详细的、有证据支持的实施方案。最终，我们期望从中获得知识。研究将促进广泛且有效的医院烟草治疗，使更多患者过上更好的生活远离烟草和心肺疾病。