将吸烟状况列为生命体征是否足以在临床实践中增加戒烟支持行动？
Is making smoking status a vital sign sufficient to increase cessation support actions in clinical practice?
作者信息
Boyle Raymond, Solberg Leif I
机构信息
HealthPartners Research Foundation, Minneapolis, Minn 55440-1524, USA.
出版信息
Ann Fam Med. 2004 Jan-Feb;2(1):22-5. doi: 10.1370/afm.38.
BACKGROUND
There is widespread belief that adding smoking status to the list of vital signs in medical practice will lead to an increased likelihood that physicians will offer more cessation support for smokers during office visits. This article evaluates the impact of introducing routine use of smoking status as a vital sign on clinician cessation support in a primary care setting.
METHODS
A total of 429 adult health plan members who were smokers and recent quitters from 2 primary care clinics in Minneapolis, Minn, were administered a 28-item questionnaire by telephone. The instrument included questions about patient health status, smoking status, advice about smoking, clinic actions during the most recent visit, satisfaction with clinic actions, and intention to change smoking. Comparisons were made with a cohort of smoking patients before and after smoking status was used as a vital sign, using 2-tailed t tests for continuous variables and chi-square analysis for categorical variables.
RESULTS
Patient self-report of receiving advice about smoking in the past year (about 66%) was unchanged after smoking status was implemented as a vital sign. Medical chart documentation of tobacco use increased from 38.0% to 78.4% of all encounters, whereas documentation of advice about smoking decreased from 33.5% to 18.8%. Except for identification of tobacco use before implementation of the guideline, none of the specific activities recommended in the guideline occurred at very high levels.
CONCLUSION
Implementing smoking status as a vital sign appears to have increased the documentation of tobacco use but had little effect on specific implementation actions. Overall, the findings suggest that more consistent identification of tobacco use alone will not lead to guideline-recommended changes in cessation support actions by clinicians. Greater environmental changes will be needed if tobacco guideline goals are to be achieved.
背景
人们普遍认为，在医疗实践中将吸烟状况纳入生命体征列表会增加医生在门诊时为吸烟者提供更多戒烟支持的可能性。本文评估了在初级保健环境中常规使用吸烟状况作为生命体征对临床医生戒烟支持的影响。
方法
通过电话对明尼苏达州明尼阿波利斯市2家初级保健诊所的429名成年健康计划成员（吸烟者和近期戒烟者）进行了一项包含28个项目的问卷调查。该问卷包括有关患者健康状况、吸烟状况、吸烟建议、最近一次就诊时诊所采取的行动、对诊所行动的满意度以及改变吸烟意愿的问题。对将吸烟状况用作生命体征前后的吸烟患者队列进行比较，连续变量使用双尾t检验，分类变量使用卡方分析。
结果
在将吸烟状况作为生命体征实施后，患者自我报告在过去一年中接受吸烟建议的比例（约66%）没有变化。医疗记录中烟草使用情况的记录从所有就诊记录的38.0%增加到78.4%，而关于吸烟建议的记录从33.5%下降到18.8%。除了在指南实施前识别烟草使用情况外，指南中推荐的具体活动均未达到很高的水平。
结论
将吸烟状况作为生命体征实施似乎增加了烟草使用情况的记录，但对具体实施行动影响不大。总体而言，研究结果表明，仅更一致地识别烟草使用情况不会导致临床医生在戒烟支持行动上做出指南推荐的改变。如果要实现烟草指南目标，将需要更大的环境变革。
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