Foo Cheryl Y S, Potter Kevin, Nielsen Lindsay, Rohila Aarushi, Maravic Melissa Culhane, Schnitzer Kristina, Pachas Gladys N, Levy Douglas E, Reyering Sally, Thorndike Anne N, Cather Corinne, Evins A Eden
Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering).
Psychiatr Serv. 2025 Jan 1;76(1):30-40. doi: 10.1176/appi.ps.20240044. Epub 2024 Aug 9.
Adults with serious mental illness have high rates of tobacco use disorder and underuse pharmacotherapy for tobacco cessation. In a previous randomized controlled trial, participants receiving community health worker (CHW) support and education for their primary care providers (PCPs) had higher tobacco abstinence rates at 2 years, partly because of increased initiation of tobacco-cessation pharmacotherapy. The authors aimed to determine the association between CHW-participant engagement and tobacco abstinence outcomes.
The authors conducted a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of the number and duration of CHW visits, number of smoking-cessation group sessions attended, and number of CHW-attended PCP visits on initiation of tobacco-cessation pharmacotherapy and tobacco abstinence were modeled via logistic regression. Interviews with 12 CHWs, 17 patient participants, and 17 PCPs were analyzed thematically.
Year 2 tobacco abstinence was significantly associated with CHW visit number (OR=1.85, 95% CI=1.29-2.66), visit duration (OR=1.51, 95% CI=1.00-2.28), and number of group sessions attended (OR=1.85, 95% CI=1.33-2.58); effects on pharmacotherapy initiation were similar. One to three CHW visits per month across 2 years were optimal for achieving abstinence. Interviews identified CHW-patient engagement facilitators (i.e., trust, goal accountability, skills reinforcement, assistance in overcoming barriers to treatment access, and adherence). Training and supervision facilitated CHW effectiveness; barriers included PCPs' and care teams' limited understanding of the CHW role.
Greater CHW-participant engagement, within feasible dose ranges, was associated with tobacco abstinence among adults with serious mental illness. Implementation of CHW interventions may benefit from further CHW training and integration within clinical teams.
患有严重精神疾病的成年人烟草使用障碍发生率高，且在戒烟药物治疗方面存在用药不足的情况。在之前的一项随机对照试验中，接受社区卫生工作者（CHW）为其初级保健提供者（PCP）提供支持和教育的参与者在2年时的戒烟率更高，部分原因是戒烟药物治疗的起始率有所提高。作者旨在确定CHW与参与者的互动程度与戒烟结果之间的关联。
作者对该试验干预组的196名参与者进行了二次混合方法分析。通过逻辑回归对CHW家访的次数和时长、参加戒烟小组会议的次数以及CHW陪同参加PCP就诊的次数对戒烟药物治疗的起始和戒烟的影响进行建模。对12名CHW、17名患者参与者和17名PCP进行的访谈进行了主题分析。
第2年的戒烟情况与CHW家访次数（比值比[OR]=1.85，95%置信区间[CI]=1.29 - 2.66）、家访时长（OR=1.51，95% CI=1.00 - 2.28）以及参加小组会议的次数（OR=1.85，95% CI=1.33 - 2.58）显著相关；对药物治疗起始的影响类似。在2年时间里每月进行1至3次CHW家访最有利于实现戒烟。访谈确定了CHW与患者互动的促进因素（即信任、目标责任、技能强化、协助克服治疗获取障碍以及坚持）。培训和监督提高了CHW的工作成效；障碍包括PCP和护理团队对CHW角色的理解有限。
在可行的剂量范围内，CHW与参与者的互动程度更高与患有严重精神疾病的成年人戒烟相关。CHW干预措施的实施可能受益于进一步的CHW培训以及在临床团队中的整合。
