Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Transl Behav Med. 2020 Feb 3;10(1):163-167. doi: 10.1093/tbm/iby108.
Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.
咨询-建议-连接（AAC）旨在将初级保健环境中的吸烟者与通过州戒烟热线提供的基于证据的烟草治疗联系起来。AAC 包括培训医务人员询问吸烟状况、建议吸烟者戒烟，并通过电子健康记录中的自动链接立即为吸烟者提供戒烟热线。我们在一个大型的医疗保障系统中进行了为期 34 个月的实施试验，评估了 AAC 在促进治疗参与和戒烟方面的效果。从 2013 年 4 月至 2016 年 2 月，AAC 在 13 家为低收入、主要为种族/少数民族吸烟者提供服务的社区诊所中实施。注册护士接受培训，将 AAC 作为标准护理的一部分实施。结果包括 (a) 治疗参与率（即确定的吸烟者中参加治疗的比例）和 (b) 6 个月时自我报告和生物化学确认的戒烟率。218915 名独特的患者记录了吸烟状况，其中 40888 人报告当前吸烟。所有确定的吸烟者中参加治疗的比例为 11.8%。6 个月时的自我报告戒烟率为 16.6%，生物化学确认的戒烟率为 4.5%。AAC 作为标准护理的一部分成功实施。与文献中报告的更传统的基于转诊的方法相比，治疗参与率很高。尽管自我报告的戒烟率与其他由戒烟热线提供的治疗研究一致，但生物化学确认的戒烟率却明显较低，而生物化学确认的戒烟率通常不会在戒烟热线研究中记录。这种差异对自我报告在大型基于人群的研究中的充分性提出了挑战。需要进行更详细和全面的调查。
