Shelley Donna, VanDevanter Nancy, Cleland Charles C, Nguyen Linh, Nguyen Nam
Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
Implement Sci. 2015 Oct 9;10:142. doi: 10.1186/s13012-015-0328-8.
Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam.
METHODS/DESIGN: The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC + referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence.
The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR) will be superior to TC alone in improving delivery of cessation assistance to smokers. The findings of this research have potential to guide large-scale adoption of promising strategies for implementing and disseminating tobacco use treatment guidelines throughout the public health system in Vietnam and will serve as a model for similar action in other LMICs.
NCT01967654.
越南的吸烟率在东南亚国家中排名第二。根据世界卫生组织（WHO）的数据，在不久的将来，通过帮助当前吸烟者戒烟，可实现烟草使用导致的死亡率的大幅下降。然而，很大程度上由于缺乏在初级保健环境中实施WHO认可的治疗指南的策略研究，像越南这样的中低收入国家（LMICs）的吸烟者难以获得治疗烟草依赖的服务。本研究的目的是在越南的26个公共社区卫生中心（CHCs）进行一项整群随机对照试验，比较两种系统层面的策略在实施基于证据的烟草使用治疗指南方面的有效性。
方法/设计：本研究将采用整群随机设计和多种数据来源（患者出院访谈、提供者和乡村卫生工作者（VHW）调查以及半结构化的提供者/VHW访谈）来研究越南临床实践指南的调整和实施过程，以及理论驱动的机制，这些机制被假设用于解释两种实施策略的比较有效性。CHCs将被随机分配到以下两种情况之一：（1）培训加临床提醒系统（TC）或（2）TC + 转介给VHW进行三次面对面咨询（TCR）。主要结局是提供者对烟草使用治疗指南的依从性。次要结局是6个月生化验证的戒烟情况。
拟议的实施策略借鉴了基于证据的方法以及越来越多的文献，这些文献支持将社区卫生工作者纳入医疗团队成员以改善预防服务可及性的有效性。我们假设这些实施策略的价值是累加的，并且纳入一个允许提供者委托提供咨询任务的转介资源（TCR）在改善向吸烟者提供戒烟援助方面将优于单独的TC。本研究的结果有可能指导在越南整个公共卫生系统中大规模采用有前景的策略来实施和传播烟草使用治疗指南，并将成为其他中低收入国家类似行动的典范。
NCT01967654。
