Abatemarco Diane J, Steinberg Michael B, Delnevo Cristine D
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
J Midwifery Womens Health. 2007 Sep-Oct;52(5):451-7. doi: 10.1016/j.jmwh.2007.03.019.
Clinical practice guidelines and evidence-based reviews confirm the efficacy of tobacco dependence treatment for pregnant women. The purpose of this study was to examine tobacco dependence treatment practices among certified nurse-midwives who treat pregnant women who smoke. Midwives were surveyed to determine knowledge, perceptions, and beliefs about tobacco cessation treatment and to identify practice environmental factors that support treatment practices. Half of all midwives had not heard of the US Public Health Service Guidelines (5 A's) to assist smokers in cessation treatment. We found varying levels of adherence to the clinical practice guidelines. Nearly all midwives routinely ask, advise, and assess; while fewer encourage patients to set a quit date or discuss medication options (assist) and perform follow-up activities (arrange). Barriers significantly associated with clinical tobacco treatment practice are lack of training and competing priorities in the visit. One-office support, a system in place to provide smoking cessation information and resources, was associated with increased practice. In summary, midwives believe they should be providing tobacco dependence treatment, yet they identify a need for training. The findings of this study also indicate that sustained practice change, which includes the entire practice environment, should be targeted to enhance tobacco dependence treatment.
临床实践指南和循证综述证实了针对孕妇的烟草依赖治疗的有效性。本研究的目的是调查为吸烟孕妇提供治疗的认证助产士的烟草依赖治疗实践。对助产士进行了调查，以确定她们关于戒烟治疗的知识、看法和信念，并确定支持治疗实践的执业环境因素。所有助产士中有一半没有听说过美国公共卫生服务指南（5A法）来帮助吸烟者进行戒烟治疗。我们发现对临床实践指南的遵守程度各不相同。几乎所有助产士都常规地询问、建议和评估；而较少有人鼓励患者设定戒烟日期或讨论药物选择（协助）以及开展后续活动（安排）。与临床烟草治疗实践显著相关的障碍是缺乏培训以及就诊时相互冲突的优先事项。单一办公室支持，即一种提供戒烟信息和资源的现成体系，与更多的实践相关。总之，助产士认为她们应该提供烟草依赖治疗，但她们也认识到需要培训。本研究的结果还表明，应针对包括整个执业环境在内的持续实践变革，以加强烟草依赖治疗。
