Sherman Scott E, Estrada Maribel, Lanto Andy B, Farmer Melissa M, Aldana Ileana
VA Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA.
J Gen Intern Med. 2007 Aug;22(8):1125-31. doi: 10.1007/s11606-007-0232-2. Epub 2007 May 25.
Smoking cessation programs are very effective, but little is known about how to get smokers to attend these programs.
To evaluate whether an "on-call" counselor increased smoking cessation program referrals and attendance.
We randomly assigned 1 of 2 primary care teams at the Sepulveda VA Ambulatory Care Center to intervention and the other to usual care. The intervention team had access to an on-call counselor who provided counseling and care coordination. Social marketing efforts included educational outreach, provider feedback, and financial incentives.
Baseline telephone interviews with a sample of 482 smokers were conducted, covering smoking history, health status, and smoking cessation treatments. Follow-up surveys were conducted at mid-intervention (n = 251) and post-intervention (n = 251).
Two hundred ninety-six patients were referred to the on-call counselor, who counseled each patient in person and provided follow-up calls. The counselor referred 45% to the on-site program, and 27% to telephone counseling; of these, half followed through on the referral; 28% declined referral. Patients on the intervention team were more likely to report being counseled about smoking (68% vs 56%; odds ratio [OR] 1.7, CI 1.0-2.9) and referred to a cessation program (38% vs 23%; OR 2.1, CI 1.2-3.6); having attended the program (11% vs 4%; OR 3.6, CI 1.2-10.5); and receiving a prescription for bupropion (17% vs 8%) (OR 2.3, CI 1.1-5.1). The effect was not sustained after the case management period.
Having access to an on-call counselor with case management increased rates of smoking cessation counseling, referral, and treatment. The intervention could be reproduced by other health care systems.
戒烟项目非常有效，但对于如何让吸烟者参加这些项目却知之甚少。
评估“随叫随到”的咨询顾问是否能增加戒烟项目的转诊和参与率。
我们将Sepulveda退伍军人事务部门诊护理中心的2个初级保健团队中的1个随机分配到干预组，另1个分配到常规护理组。干预组的团队可以使用一名随叫随到的咨询顾问，该顾问提供咨询和护理协调。社会营销努力包括教育推广、向医疗服务提供者反馈以及经济激励措施。
对482名吸烟者样本进行了基线电话访谈，内容涵盖吸烟史、健康状况和戒烟治疗情况。在干预中期（n = 251）和干预后（n = 251）进行了随访调查。
296名患者被转诊给随叫随到的咨询顾问，该顾问对每位患者进行了面对面咨询并提供了随访电话。咨询顾问将45%的患者转诊到现场项目，27%的患者转诊到电话咨询；其中，一半患者接受了转诊；28%的患者拒绝转诊。干预组的患者更有可能报告接受过吸烟咨询（68%对56%；优势比[OR] 1.7，置信区间[CI] 1.0 - 2.9）并被转诊到戒烟项目（38%对23%；OR 2.1，CI 1.2 - 3.6）；参加过该项目（11%对4%；OR 3.6，CI 1.2 - 10.5）；以及获得安非他酮处方（17%对8%）（OR 2.3，CI 1.1 - 5.1）。在病例管理期结束后，这种效果没有持续。
能够获得一名负责病例管理的随叫随到的咨询顾问提高了戒烟咨询、转诊和治疗的比例。其他医疗保健系统可以复制这种干预措施。
