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Grant Details

Grant Number: 5R01CA101963-09 Interpret this number
Primary Investigator: Ellerbeck, Edward
Organization: University Of Kansas Medical Center
Project Title: Centralized Disease Management for Rural Hospitalized Smokers
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Hospitalized smokers are at high risk for complications related to continued tobacco use. Although national attention has been directed at smoking cessation for hospitalized patients, rural hospitals have been unable to implement the complete components of effective smoking cessation programs. In this competitive renewal to Kan Quit, our experienced, multidisciplinary team will build upon our strong foundation of research on smoking cessation in rural communities. Kan Quit, directed at smokers in all stages of readiness to quit, demonstrated that disease management, in which free pharmacotherapy was combined with pharmacotherapy management, could engage 78% of smokers in effective treatment. Unfortunately, free pharmacotherapy for smoking cessation is not universally available. State smoking cessation programs have limited supplies and offer limited choices; although prescription coverage for pharmacotherapy is increasingly available, it is underutilized, particularly among the high-risk population of hospitalized smokers. Grounded in the Chronic Care Model, our revised disease management program is designed to provide counseling and disease management while increasing utilization of pharmacotherapy and enhancing support from healthcare providers. In contrast to Kan Quit, our revised disease management program will take advantage of resources for pharmacotherapy already available in the community. Our specific objectives are to 1) evaluate the effectiveness of Centralized Disease Management (CDM) for smoking cessation among hospitalized rural smokers; 2) test the impact of CDM on utilization of pharmacotherapy and discussions with health care providers; 3) clarify how utilization of these elements may mediate the effect of CDM on smoking cessation; and 4) examine the marginal cost effectiveness of CDM for smoking cessation. This study will be conducted in 30 rural critical access hospitals in Kansas. The primary outcome is 7-day point prevalence abstinence confirmed by salivary cotinine. Hospitalized rural smokers will be randomized to either CDM or counseling (C) alone (303 in each arm). All participants will receive in-hospital telephone counseling with telephone follow-up at days 3, 7, 21, and 90. A second effort will be made to re-engage persistent or relapsed smokers 6 months later. For CDM participants, our Tobacco Treatment Specialist will also provide telephone-based disease management during the hospitalization and after discharge, including supplemental support for pharmacotherapy that is consistent with their insurance plan and guidance on establishing effective discussions with their health care provider. The Tobacco Treatment Specialist will also fax treatment recommendations, prescription requests, and counseling suggestions to the healthcare provider. The proposed research will enhance our understanding of disease management for smoking cessation and, if successful, has the potential for immediate implementation in rural critical access hospitals. PUBLIC HEALTH RELEVANCE: Many hospitalized smokers do not receive effective smoking cessation treatment. In this follow-up to Kan Quit we will see if disease management for hospitalized smokers can increase use of effective pharmaco- therapy, improve communication with health care providers, and increase rates of smoking cessation.

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Publications

Ongoing self-engagement in quit attempts and cessation outcomes among rural smokers who were unable to quit after 2 years of repeated interventions.
Authors: Hui SK, Nazir N, Faseru B, Ellerbeck EF
Source: J Rural Health, 2013 Winter;29(1), p. 106-12.
EPub date: 2012 May 31.
PMID: 23289661
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Simultaneous evaluation of abstinence and relapse using a Markov chain model in smokers enrolled in a two-year randomized trial.
Authors: Yeh HW, Ellerbeck EF, Mahnken JD
Source: BMC Med Res Methodol, 2012 Jul 7;12, p. 95.
EPub date: 2012 Jul 7.
PMID: 22770436
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Change in self-efficacy, autonomous and controlled motivation predicting smoking.
Authors: Cupertino AP, Berg C, Gajewski B, Hui SK, Richter K, Catley D, Ellerbeck EF
Source: J Health Psychol, 2012 Jul;17(5), p. 640-52.
EPub date: 2011 Nov 10.
PMID: 22076554
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The impact of repeated cycles of pharmacotherapy on smoking cessation: a longitudinal cohort study.
Authors: Cupertino AP, Wick JA, Richter KP, Mussulman L, Nazir N, Ellerbeck EF
Source: Arch Intern Med, 2009 Nov 9;169(20), p. 1928-30.
PMID: 19901150
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Effect of varying levels of disease management on smoking cessation: a randomized trial.
Authors: Ellerbeck EF, Mahnken JD, Cupertino AP, Cox LS, Greiner KA, Mussulman LM, Nazir N, Shireman TI, Resnicow K, Ahluwalia JS
Source: Ann Intern Med, 2009 Apr 7;150(7), p. 437-46.
PMID: 19349629
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Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care.
Authors: Cox LS, Cupertino AP, Mussulman LM, Nazir N, Greiner KA, Mahnken JD, Ahluwalia JS, Ellerbeck EF
Source: Prev Med, 2008 Aug;47(2), p. 200-5.
EPub date: 2008 May 3.
PMID: 18544464
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Correlates of self-efficacy among rural smokers.
Authors: Berg CJ, Sanderson Cox L, Mahnken JD, Greiner KA, Ellerbeck EF
Source: J Health Psychol, 2008 Apr;13(3), p. 416-21.
PMID: 18420774
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Understanding smoking cessation in rural communities.
Authors: Hutcheson TD, Greiner KA, Ellerbeck EF, Jeffries SK, Mussulman LM, Casey GN
Source: J Rural Health, 2008 Spring;24(2), p. 116-24.
PMID: 18397444
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Smoking cessation pharmacotherapy preferences in rural primary care.
Authors: Cupertino PA, Richter KP, Cox LS, Nazir N, Greiner AK, Ahluwalia JS, Ellerbeck EF
Source: Nicotine Tob Res, 2008 Feb;10(2), p. 301-7.
PMID: 18236294
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Long-term engagement in smoking cessation counseling among rural smokers.
Authors: Cupertino AP, Mahnken JD, Richter K, Cox LS, Casey G, Resnicow K, Ellerbeck EF
Source: J Health Care Poor Underserved, 2007 Nov;18(4 Suppl), p. 39-51.
PMID: 18065851
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NF-kappaB: a potential target for cancer chemoprevention and therapy.
Authors: Sarkar FH, Li Y
Source: Front Biosci, 2008 Jan 1;13, p. 2950-9.
EPub date: 2008 Jan 1.
PMID: 17981768
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A relative color approach to color discrimination for malignant melanoma detection in dermoscopy images.
Authors: Stanley RJ, Stoecker WV, Moss RH
Source: Skin Res Technol, 2007 Feb;13(1), p. 62-72.
PMID: 17250534
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Correlates of home smoking restrictions among rural smokers.
Authors: Berg CJ, Cox LS, Nazir N, Mussulman LM, Ahluwalia JS, Ellerbeck EF
Source: Nicotine Tob Res, 2006 Jun;8(3), p. 353-60.
PMID: 16801293
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