Project 1: Break Free: Effectiveness of a multi-level smoking cessation program adapted for high-risk women in rural communities

项目 1：Break Free：针对农村社区高危女性的多层次戒烟计划的有效性

• 批准号: 10268452
• 负责人: Amy K Ferketich
• 金额: $ 1.01万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-11 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268452
• 关键词: Abstinence; Adult; Age; Appalachian Region; Attitude; Cervical; Cervical Cancer Screening; Characteristics; Client; Clinic; Clinical; Clinical Practice Guideline; Communities; Counseling; Early Intervention; Effectiveness; Electronic Health Record; Evaluation; Fees; Female; Free Will; Geography; Goals; Health Personnel; Health Services Accessibility; Health system; Healthcare Systems; High Risk Woman; Human Papilloma Virus Vaccination; Income; Intervention; Knowledge; Malignant neoplasm of cervix uteri; Measurement; Outcome; Patient Education; Patients; Pharmacotherapy; Phase; Prevention program; Primary Health Care; Process; Protocols documentation; Provider; Readiness; Recovery; Reporting; Research; Resources; Risk; Risk Factors; Risk Reduction; Rural; Rural Appalachia; Rural Community; Rural Health; Rural Population; Services; Smoker; Smoking; Smoking Cessation Intervention; Standardization; System; Telephone; Testing; Tobacco; Tobacco use; Training; United States Public Health Service; Woman; Work; arm; base; cancer risk; cervical cancer prevention; clinical practice; cost; design; effectiveness implementation study; effectiveness testing; efficacy testing; evidence base; health care settings; high risk; implementation science; improved; innovation; insurance claims; intervention program; nicotine replacement; practice setting; prevention service; primary care setting; programs; rural patients; satisfaction; smoking cessation; smoking prevalence; stem; therapy design; uptake

The prevalence of smoking (25 – 35%) in many underserved Appalachia communities is nearly double the national rate and is a major contributor to the high-risk for cervical cancer in the region. Project 1 – ‘Break Free’ (BF) will implement and test the effectiveness of a healthcare provider- and trained patient navigator-delivered smoking cessation intervention designed to reduce cervical cancer risk within an integrated cervical cancer prevention program. BF is the result of previous work of the team in adapting an evidence-based smoking cessation program to rural populations and will be tested, refined and implemented to achieve high impact and sustainability through billable cost-recovery. BF utilizes a standard format of clinical delivery of Ask, Advise and Connect (AAC) followed by 4 sessions of proactive telephone-based counseling with Nicotine Replacement Therapy support delivered to 600 adult female smokers in primary care practices of 10 non-overlapping health systems in the Appalachian region of four states (KY, OH, VA, WV). BF will be extended to all eligible smokers in the sustainability phase. Delayed versus early intervention health system groups will be compared. Project 1 is closely coordinated with the overall Program Project by providing a key component of an integrated cervical cancer risk reduction/prevention program and its overall outcome and will rely on its shared Cores for harmonization in its implementation, measurement, evaluation and dissemination processes. Project 1 aims are organized along three distinct levels of outcomes: 1) Service outcomes: Determine the effectiveness of a core component of an integrated cervical cancer prevention program designed to help female smokers quit by standardizing clinical practice supports and protocols; 2) Client outcomes: Determine satisfaction with the multilevel intervention; and 3) Implementation outcomes: Test the sustainability of the multi-level intervention via training of providers and staff on counseling and billing for evidence-based smoking cessation services. Successful implementation of BF in the diverse set of rural Appalachian clinics in participating health systems proposed, across 4 states, has the potential for a substantial and sustained impact by improving rural patients’ access to high quality, culturally sensitive, and local evidence-based smoking cessation treatment. If successfully shown to be sustainable at the clinic level, BF could be disseminated widely within rural Appalachia, as well as to healthcare systems in other underserved geographic settings.

在许多服务不足的阿巴拉契亚社区，吸烟率 (25 – 35%) 几乎是其他地区的两倍 是导致该地区宫颈癌高风险的主要原因 项目 1——“摆脱束缚”。 (BF) 将实施并测试医疗保健提供者和经过培训的患者导航员交付的有效性 旨在降低综合宫颈癌风险的戒烟干预措施 BF 是该团队之前在采用循证吸烟方面的工作成果。 向农村人口实施戒烟计划，并将对其进行测试、完善和实施，以实现高影响力和 通过可计费的成本回收实现可持续性。 BF 采用标准的临床交付格式：询问、建议和 Connect (AAC)，随后进行 4 次主动电话尼古丁替代咨询 在 10 个非重叠健康的初级保健实践中向 600 名成年女性吸烟者提供治疗支持 阿巴拉契亚地区四个州（肯塔基州、俄亥俄州、弗吉尼亚州、西弗吉尼亚州）的系统将扩展到所有符合条件的吸烟者。 在可持续发展阶段，将比较延迟干预与早期干预卫生系统项目 1。 通过提供综合颈椎病的关键组成部分，与整个计划项目密切协调 癌症风险降低/预防计划及其总体成果，并将依赖其共享核心 项目 1 的目标是协调其实施、衡量、评估和传播过程。 按照三个不同层次的成果进行组织： 1) 服务成果：确定核心的有效性 旨在帮助女性吸烟者戒烟的综合宫颈癌预防计划的一部分 标准化临床实践支持和协议；2) 客户结果：确定对多层次的满意度 干预；以及 3) 实施结果：通过以下方式测试多层次干预的可持续性： 对提供者和工作人员进行循证戒烟服务咨询和计费方面的培训。 在参与卫生系统的各种阿巴拉契亚乡村诊所成功实施 BF 跨越 4 个州的提议有可能通过改善农村患者的健康状况而产生重大和持续的影响 如果成功的话，可以获得高质量、文化敏感且基于当地证据的戒烟治疗。 事实证明，BF 在临床层面具有可持续性，可以在阿巴拉契亚农村地区以及其他地区广泛传播 其他服务不足的地理环境中的医疗保健系统。