Katz David A, Muehlenbruch Donna R, Brown Roger B, Fiore Michael C, Baker Timothy B
Department of Medicine, Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI 53705, USA.
Prev Med. 2002 Sep;35(3):293-301. doi: 10.1006/pmed.2002.1073.
The Agency for Healthcare Research and Quality Smoking Cessation Practice Guideline recommends systematic assessment of smoking status and counseling of smokers at every visit, but the actual effectiveness of the guideline in primary care practice is unknown.
We conducted a nonrandomized, controlled before-after trial of a guideline-derived intervention that includes routine identification and brief counseling of smokers by nurses and medical assistants, coupled with free nicotine replacement therapy (NRT) and telephone counseling of those smokers who are willing to make a quit attempt, and feedback on performance of guideline-recommended activities. The intervention was pilot tested at 1 family practice (FP) clinic over a 2-month period; patterns of usual care were observed concurrently at four control FP clinics. We obtained exit interviews of 651 consecutive adult smokers who presented for routine, nonemergency care. Abstinence (7-day point prevalence) was determined by telephone interview during 6-month follow-up.
Concordance with guidelines was significantly greater for all recommended actions at the test site during the intervention versus baseline (P < or = 0.05). Significantly more intervention versus baseline patients at the test site reported abstinence at 2-month follow-up (21 vs. 4%, P = 0.0004), and more patients tended to be abstinent at 6-month follow-up (21 vs. 11%, P = 0.08). No significant differences in 2- or 6-month quit rates between intervention and baseline patients were observed at the control sites.
Implementation of a guideline-driven smoking cessation intervention that focuses primarily on smokers who are interested in making a quit attempt is associated with increased abstinence in primary care practice.
医疗保健研究与质量机构的戒烟实践指南建议在每次就诊时对吸烟状况进行系统评估并为吸烟者提供咨询，但该指南在初级保健实践中的实际效果尚不清楚。
我们对一项基于指南的干预措施进行了非随机对照前后试验，该干预措施包括护士和医疗助理对吸烟者进行常规识别和简短咨询，同时提供免费尼古丁替代疗法（NRT），并为愿意尝试戒烟的吸烟者提供电话咨询，以及对指南推荐活动的执行情况进行反馈。该干预措施在1家家庭医疗（FP）诊所进行了为期2个月的试点测试；同时在4家对照FP诊所观察常规护理模式。我们对651名连续前来接受常规非紧急护理的成年吸烟者进行了出院访谈。通过6个月随访期间的电话访谈确定戒断情况（7天点患病率）。
与基线相比，干预期间试验地点所有推荐行动的指南依从性显著更高（P≤0.05）。在试验地点，与基线患者相比，干预组在2个月随访时报告戒断的患者显著更多（21%对4%，P = 0.0004），并且在6个月随访时更多患者倾向于戒断（21%对11%，P = 0.08）。在对照地点，干预组和基线患者在2个月或6个月的戒烟率上没有显著差异。
实施一项主要针对有戒烟意愿的吸烟者的指南驱动的戒烟干预措施，与初级保健实践中戒断率的提高相关。
