Bauld Linda, Coleman Tim, Adams Catherine, Pound Elspeth, Ferguson Janet
Department of Urban Studies, University of Glasgow, Glasgow, UK.
Addiction. 2005 Apr;100 Suppl 2:19-27. doi: 10.1111/j.1360-0443.2005.01024.x.
This paper describes how smoking treatment services in England were delivered beyond the initial set-up phase and explores key factors affecting their development. Services were expected to treat smokers in line with the evidence-base and were issued with government guidance regarding the type of interventions that should be offered. One factor complicating this was the issue of service funding. Funding was initially issued for a 3-year period and although this was extended on two occasions, these extensions were both announced close to the end of funding periods.
To critically assess key elements in the delivery of the English cessation services, including the nature of treatments offered and the impact of short-term funding on staffing.
A national postal survey of smoking cessation coordinators in April 2002. Semi-structured interviews with 50 smoking cessation staff in two health regions in autumn 2001, followed by further interviews with 28 staff in the same areas in the autumn of 2002.
Treatment was delivered in a wide range of venues, ranging from primary care to local authority-owned premises such as town halls and libraries. Most services offered both one-to-one and group support, although interviewees reported an increase in demand for one-to-one support from clients. Pharmacotherapies were used widely; by 2002, 99% of coordinators reported that their advisers recommended nicotine replacement therapy (NRT) to clients, and 95% bupropion. However, prior to April 2001 bupropion was available on prescription, but NRT was not and this variable access to pharmacotherapies posed problems for services. Coordinators reported that the short-term nature of funding made recruiting and retaining staff difficult and interviews revealed that they believed a longer period of protected funding was required for services to demonstrate their effectiveness.
As English smoking treatment services developed, lessons were learned that could inform the development of services in other health systems. First, early guidance from government can encourage services to adhere to evidence-based treatment. Secondly, treatment needs to be accessible to smokers and thus there must be a flexible approach to implementation at local level. Thirdly, the availability of nicotine addiction and behavioural therapies should be coordinated to minimize barriers and maximize uptake. Finally, fixed-term funding can exacerbate staff recruitment and retention difficulties and countries establishing treatment services need to consider carefully the initial funding period that is required for stable services to become established within their health systems.
本文描述了英格兰的吸烟治疗服务在初始设立阶段之后是如何提供的，并探讨了影响其发展的关键因素。这些服务应根据循证依据对吸烟者进行治疗，并收到了政府关于应提供的干预措施类型的指导意见。使这一情况复杂化的一个因素是服务资金问题。资金最初发放为期三年，尽管两次延长了期限，但这两次延期都是在资金期限接近结束时宣布的。
批判性地评估英格兰戒烟服务提供中的关键要素，包括所提供治疗的性质以及短期资金对人员配备的影响。
2002年4月对戒烟协调员进行全国邮政调查。2001年秋季对两个卫生区域的50名戒烟工作人员进行半结构化访谈，随后在2002年秋季对同一地区的28名工作人员进行进一步访谈。
治疗在广泛的场所提供，从初级保健到地方当局拥有的场所，如市政厅和图书馆。大多数服务同时提供一对一和团体支持，尽管受访者报告称客户对一对一支持的需求有所增加。药物疗法被广泛使用；到2002年，99%的协调员报告称其顾问向客户推荐尼古丁替代疗法（NRT），95%推荐安非他酮。然而，在2001年4月之前，安非他酮可凭处方获得，但NRT不行，这种药物疗法获取的差异给服务带来了问题。协调员报告称，资金的短期性质使得招聘和留住员工变得困难，访谈显示他们认为服务需要更长时间的受保护资金才能证明其有效性。
随着英格兰吸烟治疗服务的发展，吸取了一些经验教训，可为其他卫生系统中服务的发展提供参考。第一，政府的早期指导可鼓励服务遵循循证治疗。第二，吸烟者应能够获得治疗，因此在地方层面必须有灵活的实施方法。第三，应协调尼古丁成瘾和行为疗法的可及性，以尽量减少障碍并最大限度地提高接受率。最后，定期资金可能会加剧员工招聘和留用的困难，建立治疗服务的国家需要仔细考虑在其卫生系统中建立稳定服务所需的初始资金期限。
