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在全面无烟工作场所计划实施的背景下,物质使用治疗提供者提供非香烟烟草使用的 5A's 的变化。

Changes in Substance Use Treatment Providers' Delivery of the 5A's for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation.

机构信息

Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA.

Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA.

出版信息

Int J Environ Res Public Health. 2023 Feb 3;20(3):2730. doi: 10.3390/ijerph20032730.

Abstract

Tobacco use treatment is not prioritized in substance use treatment centers (SUTCs), leading to tobacco-related health inequities for patients with substance use disorders (SUDs) and necessitating efforts to enhance providers' care provision. Training providers on how to treat tobacco use increases their intervention on patients' smoking, but limited work addresses its effects on their non-cigarette tobacco use intervention provision. This study redressed this gap using data from 15 unaffiliated SUTCs in Texas (serving 82,927 patients/year) participating in a tobacco-free workplace program (TFWP) that included provider education on treating tobacco use, including non-cigarette tobacco use. SUTC providers completed surveys before (n = 259) and after (n = 194) TFWP implementation. Past-month screening/intervention provision for non-cigarette tobacco use (the 5A's; ask, advise, assess, assist, arrange) and provider factors theoretically and practically presumed to underlie change [i.e., beliefs about concurrently treating tobacco use disorder (TUD) and other SUDs, self-efficacy for tobacco use assessment (TUA) delivery, barriers to treating tobacco dependence, receipt of tobacco intervention training] were assessed. Generalized linear or linear mixed models assessed changes over time from before to after TFWP implementation; low vs. high SUTC-level changes in provider factors were examined as moderators of changes in 5A's delivery. Results indicated significant improvement in each provider factor and increases in providers' asking, assisting, and arranging for non-cigarette tobacco use over time (s < 0.04). Relative to their counterparts, SUTCs with high changes in providers' beliefs in favor of treating patients' tobacco use had greater odds of advising, assessing, assisting, and arranging patients, and SUTCs with greater barrier reductions had greater odds of advising and assisting patients. Results suggest that TFWPs can address training deficits and alter providers' beliefs about treating non-tobacco TUD during SUD care, improve their TUA delivery self-efficacy, and reduce intervention barriers, ultimately increasing intervention provision for patients' non-cigarette tobacco use. SUTCs with the greatest room for improvement in provider beliefs and barriers to care provision seem excellent candidates for TFWP implementation aimed at increasing non-cigarette tobacco use care delivery.

摘要

在物质使用治疗中心 (SUTCs) 中,烟草使用治疗并未被优先考虑,这导致了患有物质使用障碍 (SUDs) 的患者在烟草使用方面存在健康不平等现象,并需要努力增强提供者的护理提供。培训提供者如何治疗烟草使用会增加他们对患者吸烟的干预,但有限的工作涉及到对他们非香烟烟草使用干预提供的影响。本研究使用来自德克萨斯州 15 个独立的 SUTCs 的数据解决了这一差距(每年为 82927 名患者提供服务),这些 SUTCs 参与了一个无烟工作场所计划 (TFWP),该计划包括对烟草使用治疗的提供者教育,包括非香烟烟草使用治疗。SUTC 提供者在 TFWP 实施前后完成了调查(n = 259)。对非香烟烟草使用的过去一个月筛查/干预提供(5A's;询问、建议、评估、协助、安排)以及理论上和实践上被认为是改变基础的提供者因素[即同时治疗烟草使用障碍 (TUD) 和其他 SUD 的信念、烟草使用评估 (TUA) 交付的自我效能、治疗烟草依赖的障碍、接受烟草干预培训]进行了评估。广义线性或线性混合模型评估了 TFWP 实施前后随时间的变化;低与高 SUTC 水平提供者因素变化被视为 5A 交付变化的调节剂。结果表明,每个提供者因素都有显著改善,并且随着时间的推移,提供者在询问、协助和安排非香烟烟草使用方面的增加(s < 0.04)。与对照组相比,对治疗患者烟草使用的信念变化较大的 SUTCs 更有可能为患者提供建议、评估、协助和安排,而干预障碍减少较大的 SUTCs 更有可能为患者提供建议和协助。结果表明,TFWPs 可以解决培训不足的问题,并改变提供者在 SUD 护理过程中对治疗非烟草 TUD 的信念,提高他们的 TUA 交付自我效能,并减少干预障碍,最终增加对患者非香烟烟草使用的干预提供。在提供者信念和护理提供障碍方面有最大改进空间的 SUTCs 似乎是实施旨在增加非香烟烟草使用护理提供的 TFWP 的优秀候选者。

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