主动的人群健康策略，为初级保健实践网络中的吸烟者提供烟草依赖治疗。
Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network.
机构信息
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
出版信息
J Gen Intern Med. 2019 Aug;34(8):1571-1577. doi: 10.1007/s11606-019-05079-3. Epub 2019 Jun 13.
BACKGROUND
Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters.
OBJECTIVE
To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters.
DESIGN
3-arm pragmatic randomized controlled trial.
PARTICIPANTS
Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls.
INTERVENTIONS
One intervention group involved engagement with a health system-based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral).
MEASUREMENTS
Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment.
KEY RESULTS
Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p < 0.001), cessation medication prescription (52% vs. 30%, p = 0.002), and counseling (47% vs. 9%, p < 0.001). Internal care coordination was more effective than external community referral at connecting smokers to any cessation treatment (76% vs. 50%, p = 0.001) and at providing cessation medication (66% vs. 39%, p < 0.001), but comparable at linking smokers to cessation counseling resources.
CONCLUSIONS
Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03612895.
背景
基于人群的策略可以将戒烟治疗的覆盖面扩大到临床接触之外。
目的
确定两种基于人群的戒烟策略与常规护理相比，在提供临床接触之外的戒烟治疗方面的效果。
设计
三臂实用随机对照试验。
参与者
通过电子健康记录（n=5225）确定马萨诸塞州五家社区卫生中心的一名初级保健提供者的≥18 岁的当前吸烟者，并通过自动电话招募他们。
干预措施
一个干预组涉及与基于健康系统的烟草辅导员（内部护理协调）接触，另一个将患者与全国戒烟热线（外部社区转介）联系起来。
测量
入组后 6 个月内有任何基于证据的戒烟治疗记录的吸烟者比例。
主要结果
在对主动治疗提议做出回应的 639 人中，有 233 人同意并以 1:1:1 的比例随机分配到研究组。在 6 个月的随访中，与常规护理相比， pooled 干预组有更高比例的任何戒烟治疗记录（63%比 34%，p<0.001）、戒烟药物处方（52%比 30%，p=0.002）和咨询（47%比 9%，p<0.001）。内部护理协调在将吸烟者与任何戒烟治疗（76%比 50%，p=0.001）和提供戒烟药物（66%比 39%，p<0.001）方面比外部社区转介更有效，但在将吸烟者与戒烟咨询资源联系起来方面效果相当。
结论
对基于人群的主动外展策略做出回应的吸烟者在被转介到基于健康系统或社区的计划时，与常规护理相比，提供的烟草戒断治疗更好。在几个方面，基于健康系统的策略优于戒烟热线。未来的工作应该旨在提高人群的覆盖面，并测试对戒烟率的影响。
试验注册
ClinicalTrials.gov NCT03612895。
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