Abstract

Objective: 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). Methods: 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. Results: Participants (n = 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. Conclusions: 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.

摘要

目标：尽管烟草使用在严重精神疾病患者中的流行率很高，但社区精神卫生保健机构中很少涉及烟草使用问题。本研究的目的是收集利益相关者关于社区心理健康中心 (CMHC) 烟草依赖慢性护理管理策略可行性的反馈。评估的慢性病护理策​​略包括 5 A（询问烟草使用情况、建议烟草使用者戒烟、评估戒烟兴趣、协助戒烟和安排后续行动）和主动电话外展（与所有烟草使用者联系，以了解烟草使用情况）。提供与戒烟治疗的联系）。方法：我们使用以实用稳健实施和可持续性模型为基础的半结构化访谈指南，对两个 CMHC 的提供者、领导者和客户进行了单独的半结构化访谈。我们的目标是了解他们对戒烟治疗、两种长期护理模式干预措施（即主动外展，5A）的态度，并确定在他们的 CMHC 中实施此类干预措施所需的基础设施。主题分析由两名独立编码员进行，以揭示相关主题。结果：参与者 ( n = 20）包括 9 个提供商、6 个领导者和 5 个客户。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，以及 (3) 实施和可持续性所需的基础设施。提供者、领导者和客户都报告说，CMHC 很少提供戒烟治疗，并表示有兴趣提供更多此类治疗。5A 和主动外展被认为是可行的并且可以接受。提供者、领导者和客户希望获得支持，将客户与戒烟治疗联系起来。提供者和领导者要求提供一系列实施支持，包括教学培训、决策辅助、绩效反馈、并为患有严重精神疾病的人提供基于证据的戒烟治疗指导。客户请求戒烟资源，例如 CMHC 提供的戒烟咨询和戒烟药物处方。结论： CMHC 提供者、领导者和客户有兴趣使戒烟服务更广泛地获得和提供。本研究中收集的反馈可用于为 CMHC 中遵守指南的烟草依赖护理的提供和实施提供信息。