|Grant Number:||3R01CA071358-04S1 Interpret this number|
|Primary Investigator:||Swan, Gary|
|Project Title:||Treatment of Nicotine Dependence in an Hmo Setting|
DESCRIPTION: In the grant CA71358, Treatment of Nicotine Dependence in and HMO Setting, we conducted a large randomized field trial of the effectiveness of two different doses of bupropion SR (150mg or 300mg) in combination with two different approaches to behavioral support (the Zyban Advantage Plan (ZAP), a personalized mailing program or Free & Clear, a proactive telephone-based smoking cessation program). The trial, conducted at Group Health Cooperative (GHC), showed that the higher dose was associated with short-term outcome (similar to the one industry-sponsored trial of different dosing levels) but that higher intensity behavioral counseling was associated with long-term effectiveness. The trial was limited to patients enrolled in the staff model system at GHC and did not include patients under the care of physicians in the GHC "network" - community doctors, group practices, and other hospitals contracted with GHC. In this application we seek to disseminate to 500-700 "networked" providers within GHC Northwest District three main study findings: 1) that a relatively stand-alone recruitment and screening system with physician back-up can result in safe and effective treatment of their smoking patients; 2) that a higher dose of bupropion SR was effective in the short run but more so in combination with the moderately intensive Free & Clear program and that even the lower dose of buproprion SR in combination with Free & Clear program can result in satisfactory outcomes at 12 months; and 3) that encouraging concomitant use of a behavioral support program is a more effective addition to a course of bupropion SR than simply using a higher dose. As part of this dissemination effort we aim to: 1) provide feedback to the targeted populations from the original trial (smokers, GHC staff model physicians); and 2) disseminate the findings from the trial to GHC-contracted physicians and health care providers who were not actively informed while it was being conducted (the "network" physicians) by: a) utilizing components of the Precede-Proceed Model of Health Promotion Planning to devise, in collaboration with the intended audience, an approach to dissemination of the trial's findings and methods that will maximize use of available GHC resources; b) utilizing the theoretical framework provided by Moulding, Silagy and Weller for designing effective dissemination practices; and c) assessing process and outcome measures including elements of the RE-AIM model of Glasgow, Vogt, and Boles to evaluate the dissemination effort. Effective dissemination of the trial's findings will result in greater utilization of behavioral counseling and possibly lower dosages of bupropion SR in the treatment of smokers at GHC. Thus, more efficient use of existing resources will result in greater reach of cessation efforts to smoking patients.
Canary in a coal mine? Interest in bupropion SR use among smokers in the COMPASS trial.
Authors: McClure JB, Jack L, Deprey M, Catz S, McAfee T, Zbikowski S, Westbrook E, Swan G
Source: Nicotine Tob Res, 2008 Dec;10(12), p. 1815-6.
Predictors of 12-month outcome in smokers who received bupropion sustained-release for smoking cessation.
Authors: Swan GE, Jack LM, Javitz HS, McAfee T, McClure JB
Source: CNS Drugs, 2008;22(3), p. 239-56.
Joint effect of dopaminergic genes on likelihood of smoking following treatment with bupropion SR.
Authors: Swan GE, Jack LM, Valdes AM, Ring HZ, Ton CC, Curry SJ, McAfee T
Source: Health Psychol, 2007 May;26(3), p. 361-8.
Tailoring nicotine replacement therapy: rationale and potential approaches.
Authors: McClure JB, Swan GE
Source: CNS Drugs, 2006;20(4), p. 281-91.
Financial burden of tobacco use: an employer's perspective.
Authors: Javitz HS, Zbikowski SM, Swan GE, Jack LM
Source: Clin Occup Environ Med, 2006;5(1), p. 9-29, vii.
Smoking cessation treatment: pharmacogenetic assessment.
Authors: Munaf˛ MR, Lerman C, Niaura R, Shields AE, Swan GE
Source: Curr Opin Mol Ther, 2005 Jun;7(3), p. 202-8.
Dopamine receptor DRD2 genotype and smoking cessation outcome following treatment with bupropion SR.
Authors: Swan GE, Valdes AM, Ring HZ, Khroyan TV, Jack LM, Ton CC, Curry SJ, McAfee T
Source: Pharmacogenomics J, 2005;5(1), p. 21-9.
Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer's perspective.
Authors: Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker D, Patterson R, Jack LM
Source: Value Health, 2004 Sep-Oct;7(5), p. 535-43.
Cost-effectiveness of different combinations of bupropion SR dose and behavioral treatment for smoking cessation: a societal perspective.
Authors: Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker DL, Patterson R, Jack LM
Source: Am J Manag Care, 2004 Mar;10(3), p. 217-26.
Heterogeneity in 12-month outcome among female and male smokers.
Authors: Swan GE, Javitz HS, Jack LM, Curry SJ, McAfee T
Source: Addiction, 2004 Feb;99(2), p. 237-50.
Bupropion SR and counseling for smoking cessation in actual practice: predictors of outcome.
Authors: Swan GE, Jack LM, Curry S, Chorost M, Javitz H, McAfee T, Dacey S
Source: Nicotine Tob Res, 2003 Dec;5(6), p. 911-21.
Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial.
Authors: Swan GE, McAfee T, Curry SJ, Jack LM, Javitz H, Dacey S, Bergman K
Source: Arch Intern Med, 2003 Oct 27;163(19), p. 2337-44.
Bupropion SR and smoking cessation in actual practice: methods for recruitment, screening, and exclusion for a field trial in a managed-care setting.
Authors: Jack LM, Swan GE, Thompson E, Curry SJ, McAfee T, Dacey S, Bergman K
Source: Prev Med, 2003 May;36(5), p. 585-93.
A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins.
Authors: Li MD, Cheng R, Ma JZ, Swan GE
Source: Addiction, 2003 Jan;98(1), p. 23-31.