Quinn Virginia P, Stevens Victor J, Hollis Jack F, Rigotti Nancy A, Solberg Leif I, Gordon Nancy, Ritzwoller Debra, Smith K Sabina, Hu Weiming, Zapka Jane
Kaiser Permanente Southern California, Research & Evaluation Department, Pasadena, California 91188, USA.
Am J Prev Med. 2005 Aug;29(2):77-84. doi: 10.1016/j.amepre.2005.04.006.
The U.S. Public Health Service clinical practice guideline calls for clinicians and healthcare organizations to identify and treat every tobacco user seen in a healthcare setting. There is little information on the extent of compliance with the guideline's treatment model described by the "5A's" (Ask, Advise, Assess, Assist, Arrange).
In 1999-2000 a survey was mailed to 64,764 members aged 25 to 75 years, of nine nonprofit HMOs participating in the National Cancer Institute-funded Cancer Research Network. These plans provide medical care to more than 8 million Americans including a minority enrollment of 30%. Smokers were asked about tobacco-cessation treatments received during primary care visits in the past year.
A 70% response rate identified a smoking prevalence of 10% (n=4207). Results indicated that 90% of smokers were asked about smoking, 71% were advised to quit, 56% were assessed for their willingness to quit, 49% received assistance interventions, and 9% had follow-up arranged. Treatment was provided more often to smokers who asked for help and/or intended to quit. Few and only modest associations were found between other patient characteristics and receipt of 5A's cessation services. In contrast to widely reported concerns about smokers' resistance to tobacco interventions, smokers who received treatment were more satisfied with health plan services.
Results demonstrate substantial clinician compliance with the first two steps-Ask and Advise. Greater efforts are needed in providing the more effective tobacco treatments-Assist and Arrange. Compliance with the guideline is associated with greater patient satisfaction.
美国公共卫生服务临床实践指南要求临床医生和医疗保健机构识别并治疗在医疗环境中见到的每一位烟草使用者。关于遵循“5A 法”（询问、建议、评估、协助、安排）所描述的指南治疗模式的程度，几乎没有相关信息。
1999 年至 2000 年，向参与美国国立癌症研究所资助的癌症研究网络的 9 个非营利性健康维护组织（HMO）中年龄在 25 至 75 岁的 64764 名成员邮寄了调查问卷。这些计划为超过 800 万美国人提供医疗服务，其中少数族裔参保率为 30%。吸烟者被问及过去一年在初级保健就诊期间接受的戒烟治疗情况。
70%的回复率确定吸烟率为 10%（n = 4207）。结果表明，90%的吸烟者被询问过吸烟情况，71%被建议戒烟，56%被评估了戒烟意愿，49%接受了协助干预，9%有后续安排。对于寻求帮助和/或打算戒烟的吸烟者，提供治疗的情况更为常见。在其他患者特征与接受“5A”戒烟服务之间，发现的关联很少且程度适中。与广泛报道的吸烟者对烟草干预措施的抵触担忧相反，接受治疗的吸烟者对健康计划服务更满意。
结果表明临床医生在很大程度上遵循了前两个步骤——询问和建议。在提供更有效的烟草治疗措施——协助和安排方面，还需要做出更大努力。遵循该指南与更高的患者满意度相关。
