Kaplan Celia Patricia, Pérez-Stable Eliseo J, Fuentes-Afflick Elena, Gildengorin Virginia, Millstein Susan, Juarez-Reyes Maria
Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, 94143, USA.
Arch Pediatr Adolesc Med. 2004 Jan;158(1):83-90. doi: 10.1001/archpedi.158.1.83.
To investigate family physicians' and pediatricians' practice of and perceived barriers to smoking cessation counseling among patients 18 years and younger.
Cross-sectional mail survey conducted between November 1, 1997, and January 31, 1998.
A stratified random sample selected from the 1997 American Medical Association Physician Masterfile of 1000 family physicians and pediatricians who practice in urban California, work at least 10% of the time in ambulatory care, and have at least 10% of patients 18 years and younger.
Physicians' adherence to 5 components of the National Cancer Institute's smoking cessation counseling recommendations (anticipate, ask, advise, assist, and arrange) and their perceived barriers to smoking cessation counseling.
A total of 429 physicians participated in the study. Physicians of both specialties were more likely to anticipate, ask, and advise patients about smoking than to assist with and arrange cessation activities. Family physicians were more likely than pediatricians to assist and arrange, including scheduling follow-up visits to discuss quitting (25.1% vs 11.7%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.22-7.73) and directing nursing staff to counsel patients (17.1% vs 10.9%; OR, 3.70; 95% CI, 1.30-10.60). The most common perceived barrier to counseling was the belief that children would provide inaccurate responses due to either the presence of parents (86.4%) or the fear that parents would be notified of their answers (74.0%). Pediatricians reported lack of counseling skills as a barrier to providing smoking interventions in greater proportion than did family physicians (24.9% vs 54.8%; OR, 0.29; 95% CI, 0.14-0.63; P<.001).
Improvement in smoking cessation counseling skills and practices is needed among physicians treating children and adolescents.
调查家庭医生和儿科医生针对18岁及以下患者进行戒烟咨询的实践情况以及他们所感知到的障碍。
1997年11月1日至1998年1月31日期间进行的横断面邮寄调查。
从1997年美国医学协会医生主档案中选取的分层随机样本，包括1000名在加利福尼亚州城市执业、至少10%的工作时间用于门诊护理且至少10%的患者为18岁及以下的家庭医生和儿科医生。
医生对美国国立癌症研究所戒烟咨询建议的五个组成部分（预期、询问、建议、协助和安排）的遵循情况以及他们所感知到的戒烟咨询障碍。
共有429名医生参与了该研究。两个专业的医生在预期、询问和建议患者吸烟方面比协助和安排戒烟活动方面更有可能。家庭医生比儿科医生更有可能协助和安排，包括安排后续就诊以讨论戒烟（25.1%对11.7%；优势比[OR]，3.07；95%置信区间[CI]，1.22 - 7.73）以及指导护理人员为患者提供咨询（17.1%对10.9%；OR，3.70；95% CI，1.30 - 至10.60）。最常见的咨询障碍是认为由于父母在场（86.4%）或担心父母会得知孩子的回答（74.0%），儿童会给出不准确的回答。儿科医生报告缺乏咨询技能是提供吸烟干预的障碍，其比例高于家庭医生（24.9%对54.8%；OR，0.29；95% CI，0.14 - 0.63；P <.001）。
治疗儿童和青少年的医生需要提高戒烟咨询技能和实践水平。
