Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
J Dual Diagn. 2022 Jul-Sep;18(3):153-164. doi: 10.1080/15504263.2022.2090647. Epub 2022 Jun 28.
Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. Participants ( = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs.
尽管在患有严重精神疾病的人群中，吸烟很普遍，但在社区精神卫生保健环境中，吸烟问题很少得到解决。本研究的目的是收集利益相关者对社区精神卫生中心（CMHC）中烟草依赖的慢性病管理策略可行性的反馈。评估的慢性病管理策略包括 5A（询问吸烟情况、建议吸烟者戒烟、评估戒烟意愿、帮助戒烟、安排随访）和主动电话外展（向所有吸烟者提供联系以接受戒烟治疗）。使用实用稳健实施和可持续性模型指导的半结构化访谈指南，我们在两个 CMHC 中对提供者、领导和客户进行了个人半结构化访谈。我们的目标是了解他们对戒烟治疗的态度、两种慢性病管理模式干预措施（即主动外展、5A），并确定在其 CMHC 中实施这些干预措施所需的基础设施。两位独立的编码员对主题分析进行了分析，以揭示相关主题。参与者（n=20）包括 9 名提供者、6 名领导和 5 名客户。主题分析揭示了三个主要主题：（1）接受者的特征；（2）干预措施的特征；（3）实施和可持续性所需的基础设施。提供者、领导和客户均报告称，CMHC 很少提供戒烟治疗，并表示希望提供更多此类治疗。5A 和主动外展被认为是可行且可接受的提供和接受方式。提供者、领导和客户都希望得到支持，将客户与戒烟治疗联系起来。提供者和领导要求提供一系列实施支持，包括针对严重精神疾病患者的基于证据的戒烟治疗的教学培训、决策辅助、绩效反馈和辅导。客户要求提供戒烟资源，例如在 CMHC 提供的戒烟咨询和戒烟药物处方。CMHC 的提供者、领导和客户都有兴趣使戒烟服务更广泛地普及和提供。本研究中收集的反馈可以为 CMHC 中遵循指南的烟草依赖护理的提供和实施提供信息。
