Partin Melissa R, An Lawrence C, Nelson David B, Nugent Sean, Snyder Annamay, Fu Steven S, Willenbring Mark L, Joseph Anne M
Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
Am J Prev Med. 2006 Oct;31(4):293-9. doi: 10.1016/j.amepre.2006.06.021. Epub 2006 Aug 22.
Tobacco dependence is a chronic condition requiring repeat treatment and long-term follow-up. However, current evidence regarding best approaches to providing these services is fairly limited. This study assessed the effectiveness of an intervention for increasing repeat tobacco-dependence treatment in a population of relapsed smokers.
The study was a multicenter randomized controlled trial.
SETTING/PARTICIPANTS: Patients aged 19 and older receiving a prescription for nicotine replacement therapy or bupropion for smoking cessation in 2002 at one of five participating Veterans Affairs (VA) facilities were eligible.
A total of 1900 eligible veterans were randomized to (1) patient phone call to assess smoking status, quit challenges, and treatment preferences, and computerized progress note to providers communicating this information (intervention); or (2) usual care (control).
Outcomes, assessed in 2003, included the proportion of patients receiving repeat pharmacologic or behavioral smoking-cessation treatment in the 6-month follow-up period (assessed from VA pharmacy and outpatient data), 7-day point prevalence abstinence, and satisfaction (assessed by patient survey).
Thirty-four percent of intervention participants versus 22% of controls received treatment for tobacco dependence in the follow-up period (p = 0.0001). Thirty-two percent of intervention participants versus 21% of controls received pharmacologic treatment (p = 0.0001), and 12% of intervention subjects versus 8% of controls received behavioral treatment (p = 0.005). Abstinence rates at follow-up were 25% for intervention subjects and 22% for controls (p = 0.15). Intervention subjects were more likely than controls to report being satisfied with the general smoking-cessation help (87% vs 82%, p = 0.01), as well as the pharmacologic help that they received from the VA (89 vs 84%, p = 0.01).
The intervention significantly increased repeat treatment rates and satisfaction with services but did not have a significant effect on abstinence rates.
烟草依赖是一种慢性病，需要反复治疗和长期随访。然而，目前关于提供这些服务的最佳方法的证据相当有限。本研究评估了一种干预措施在复吸吸烟者群体中增加重复烟草依赖治疗的有效性。
该研究为多中心随机对照试验。
设置/参与者：2002年在五个参与研究的退伍军人事务（VA）机构之一接受尼古丁替代疗法或安非他酮戒烟处方的19岁及以上患者符合条件。
总共1900名符合条件的退伍军人被随机分为两组：（1）通过患者电话评估吸烟状况、戒烟挑战和治疗偏好，并向提供者发送传达此信息的计算机化病程记录（干预组）；或（2）常规护理（对照组）。
2003年评估的结果包括在6个月随访期内接受重复药物或行为戒烟治疗的患者比例（根据VA药房和门诊数据评估）、7天点患病率戒烟率以及满意度（通过患者调查评估）。
在随访期内，34%的干预组参与者与22%的对照组参与者接受了烟草依赖治疗（p = 0.0001）。32%的干预组参与者与21%的对照组参与者接受了药物治疗（p = 0.0001），12%的干预组受试者与8%的对照组参与者接受了行为治疗（p = 0.005）。随访时的戒烟率干预组为25%，对照组为22%（p = 0.15）。干预组受试者比对照组更有可能报告对总体戒烟帮助感到满意（87%对82%，p = 0.01），以及对他们从VA获得的药物帮助感到满意（89%对84%，p = 0.01）。
该干预措施显著提高了重复治疗率和对服务的满意度，但对戒烟率没有显著影响。
