Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
Hoover Editing, Asheville, NC, USA.
Transl Behav Med. 2023 Aug 11;13(8):551-560. doi: 10.1093/tbm/ibad007.
Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.
问-建议-联系（AAC）通过培训诊所工作人员，系统地询问患者吸烟状况、建议吸烟者戒烟，并通过电子健康记录将患者与州戒烟热线联系起来，从而有效地将医疗保健环境中的吸烟者与基于证据的戒烟热线提供的烟草治疗联系起来。本研究采用混合方法，以 RE-AIM 框架为指导，评估 AAC 在一家合格的联邦健康中心（FQHC）中的实施情况。AAC 在一家主要为低收入社会经济地位（SES）拉丁裔和拉丁裔服务的 FQHC 中实施了 18 个月。结果在 RE-AIM 概念框架内呈现，该框架包括覆盖范围、有效性、采用、实施和维持的维度。计算了到达、有效性和影响的定量患者水平结果。实施后，对诊所领导和工作人员（N=9）进行了深入访谈，以收集意见并为未来的实施工作提供信息。在实施期间，报告目前吸烟的 GNHC 患者中有 12.0%同意将其信息发送至戒烟热线，且成功与戒烟热线取得联系（到达），与戒烟热线交谈的患者中有 94.8%接受了治疗（有效），所有确定的吸烟者中有 11.4%参加了戒烟热线治疗（影响）。在评估 RE-AIM 维度的实施后访谈中，诊所工作人员和领导确定了 AAC 的促进因素和优势，并报告说 AAC 易于学习和实施，简化了现有程序，并对患者产生了积极影响。工作人员和领导对 AAC 的实施表示热情，并认为 AAC 非常适合诊所。工作人员对 AAC 成为标准护理感兴趣，并对未来的实施提出了建议。一家主要为低收入 SES 拉丁裔和拉丁裔服务的 FQHC 的诊所工作人员对 AAC 的实施过程持积极态度。研究结果对简化临床戒烟程序和减少与烟草相关的差异具有重要意义。
