Taylor C Barr, Curry Susan J
Department of Psychiatry, Stanford University School of Medicine, CA, USA.
Ann Behav Med. 2004 Feb;27(1):13-21. doi: 10.1207/s15324796abm2701_3.
Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings.
We examined issues related to the implementation of guidelines in MCOs, to provide examples of studies that have addressed issues related to guideline implementation and to suggest ways behavioral medicine researchers can play a role in examining issues of how guidelines can be better implemented.
Surveys of clinical guideline implementation, studies from the Robert Wood Johnson Foundation addressing tobacco use cessation in a managed care database, selected to illustrate issues related to system-wide implementation.
Surveys show that effective tobacco use cessation interventions remain underutilized in MCOs. A few studies have evaluated and shown the benefit of insurance coverage for tobacco use and dependence treatments, clinician reimbursement and leadership incentives, practice feedback, and leveraging administrative data to create tobacco use tracking systems. The studies also point to the need for large-scale, multidisciplinary, methodologically rigorous studies that allow one to isolate the effects of promising strategies as well as to explore synergistic effects as different system changes are combined.
Tobacco use cessation guidelines need to be better implemented in MCOs. Behavioral medicine research needs to move beyond treatment efficacy and effectiveness studies to focus on rigorous evaluations of these and other strategies to enhance guideline implementation and dissemination.
尽管管理式医疗组织（MCOs）可能是实施戒烟临床指南的理想场所，但在许多MCO环境中，此类指南的实施情况仍然不佳。
我们研究了与MCOs中指南实施相关的问题，以提供解决指南实施相关问题的研究示例，并建议行为医学研究人员如何在研究如何更好地实施指南的问题中发挥作用。
对临床指南实施情况进行调查，选取罗伯特·伍德·约翰逊基金会在管理式医疗数据库中开展的关于戒烟的研究，以说明与全系统实施相关的问题。
调查显示，有效的戒烟干预措施在MCOs中仍未得到充分利用。一些研究评估并表明了烟草使用和依赖治疗的保险覆盖、临床医生报销和领导激励、实践反馈以及利用行政数据创建烟草使用跟踪系统的益处。这些研究还指出，需要开展大规模、多学科、方法严谨的研究，以便能够分离出有前景策略的效果，并在不同系统变化相结合时探索协同效应。
戒烟指南需要在MCOs中得到更好的实施。行为医学研究需要超越治疗效果和有效性研究，专注于对这些及其他策略进行严谨评估，以加强指南的实施和传播。
