Milch Catherine E, Edmunson Janet M, Beshansky Joni R, Griffith John L, Selker Harry P
Division of Clinical Care Research, Tufts New England Medical Center, Boston, MA 02111, USA.
Prev Med. 2004 Mar;38(3):284-94. doi: 10.1016/j.ypmed.2003.09.045.
Many primary care practices do not have systematic protocols to identify patients who smoke or to encourage clinicians to provide smoking cessation advice. We designed a study to assess the relative effectiveness of two brief interventions on screening for smoking, physician cessation advice and patient smoking cessation rates.
We performed a nonrandomized comparison of alternative strategies for smoking cessation at a hospital-based adult primary care practice. Each intervention was implemented on a separate practice team. The "minimal" intervention consisted of a smoking status "vital sign" stamp which documented patient smoking status. The "enhanced" intervention consisted of a five-question form that assessed patient level of cessation readiness and provided cessation-counseling prompts for clinicians. Medical record documentation of screening for smoking and cessation advice and self-reported patient smoking cessation rates were collected 8-10 months after implementation.
Smoking status was documented at 86%, 91%, and 49%, and cessation advice at 38%, 47%, and 30% of visits on the minimal, enhanced, and control teams, respectively (P < 0.001 for smoking status and P = 0.014 for advice). Self-reported patient smoking cessation was higher on the enhanced team (12%) compared with the minimal (2%) and control (4%) teams (P < 0.001).
A short questionnaire that assesses readiness-to-quit and provides documentation of cessation advice improves rates of clinician cessation advice and patient smoking cessation compared with no intervention.
许多初级保健机构没有系统的方案来识别吸烟患者或鼓励临床医生提供戒烟建议。我们设计了一项研究，以评估两种简短干预措施在吸烟筛查、医生戒烟建议和患者戒烟率方面的相对有效性。
我们在一家医院的成人初级保健机构对不同的戒烟策略进行了非随机比较。每种干预措施在一个独立的医疗团队中实施。“最小化”干预措施包括一个记录患者吸烟状况的吸烟状态“生命体征”印章。“强化”干预措施包括一份包含五个问题的表格，用于评估患者的戒烟准备程度，并为临床医生提供戒烟咨询提示。在实施干预措施8至10个月后，收集了吸烟筛查和戒烟建议的病历记录以及患者自我报告的戒烟率。
在最小化、强化和对照组中，分别有86%、91%和49%的就诊记录了吸烟状况，有38%、47%和30%的就诊提供了戒烟建议（吸烟状况P<0.001，建议P = 0.014）。与最小化组（2%）和对照组（4%）相比，强化组患者自我报告的戒烟率更高（12%）（P<0.001）。
与无干预措施相比，一份评估戒烟意愿并提供戒烟建议记录的简短问卷可提高临床医生的戒烟建议率和患者的戒烟率。
