Prochaska Judith J, Fromont Sebastien C, Leek Desiree, Hudmon Karen Suchanek, Louie Alan K, Jacobs Marc H, Hall Sharon M
Department of Psychiatry, University of California, San Francisco, CA 94143-0984, USA.
Acad Psychiatry. 2008 Nov-Dec;32(6):484-92. doi: 10.1176/appi.ap.32.6.484.
Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness.
The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005-2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California.
The curriculum was associated with improvements in psychiatry residents' knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months' follow-up. Residents' self-reported changes in treating patients' tobacco use were substantiated through systematic chart review.
The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.
患有精神疾病和成瘾性障碍的吸烟者在美国所消费的香烟中占了近一半，且面临与吸烟相关的死亡和残疾的高风险。精神病学住院医师培训项目为传播烟草治疗指南、影响专业规范以及增加患有精神疾病的吸烟者获得戒烟服务的机会提供了一个独特的平台。本研究评估了为精神病学住院医师培训项目开发的“精神病学变革处方”课程，该课程侧重于识别和治疗患有精神疾病的个体的烟草依赖。
这个4小时的课程强调了基于证据的、以患者为导向的戒烟治疗方法，适用于所有烟草使用者，包括那些尚未准备好戒烟的人。该课程是在全面的文献综述、与专家咨询小组的磋商、教员访谈以及与精神病学住院医师的焦点小组讨论的基础上制定的。本研究报告了2005 - 2006年对该课程的评估，采用准实验设计，涉及北加利福尼亚州三个精神病学住院医师培训项目中的55名住院医师。
该课程与精神病学住院医师在治疗患者烟草使用方面的知识、态度、信心和咨询行为的改善相关，培训前到培训后的初始变化在3个月的随访中得以维持。通过系统的病历审查证实了住院医师在治疗患者烟草使用方面自我报告的变化。
基于证据的“精神病学变革处方”课程作为一种模范烟草治疗课程提供，可在精神病学住院医师培训项目中实施并广泛传播，从而有效地惠及易受影响且成本高昂的吸烟者群体。
