Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR 97227-1110, USA.
J Public Health Dent. 2009 Summer;69(3):149-55. doi: 10.1111/j.1752-7325.2008.00113.x.
The objectives of this study are to design and implement a system-level tobacco-control intervention in a large prepaid dental group practice and assess effects on staff performance measures and patient satisfaction.
We matched 14 dental facilities on size, socioeconomic status, smoking rate, and periodontal status, and then randomly assigned them to intervention or usual-care control. We trained intervention staff in an "Assisted Referral" team approach for assessing tobacco use, providing tailored advice and brief counseling, and encouraging smokers to talk by telephone with a specially trained tobacco counselor. Patients could call from the office or ask that the counselor call them later. Telephone counselors helped patients explore motivations and barriers for quitting; review available cessation-support strategies, programs, and medications; and identify next steps.
During the 14-month study period, 66,516 members had annual- or new-patient examinations. Both intervention and control sites had high rates of tobacco assessment (97 percent) and advice (93 percent). Intervention patients were more likely than controls (69 percent versus 3 percent, P < 0.01) to receive additional chair-side tobacco counseling and assistance, and 11 percent agreed to receive additional telephone counseling. Intervention patients were more satisfied than controls with the dental team's tobacco-control efforts (P < 0.03). Referral rates varied substantially for different staff.
The Assisted Referral approach was successfully integrated into routine dental care, was well received by patients, and resulted in increased patient satisfaction. Because free telephone-based tobacco counseling is now available nationwide, the approach may be a practical strategy for most dental-care settings.
本研究旨在为一家大型预付牙科集团实施一项基于系统的控烟干预，并评估其对员工绩效指标和患者满意度的影响。
我们根据规模、社会经济地位、吸烟率和牙周状况将 14 个牙科诊所匹配起来，然后将其随机分配到干预组或常规护理对照组。我们对干预组的工作人员进行了“辅助转诊”团队方法的培训，以评估烟草使用情况、提供量身定制的建议和简短的咨询，并鼓励吸烟者通过专门培训的烟草顾问进行电话交谈。患者可以在办公室打电话或要求顾问稍后打电话给他们。电话顾问帮助患者探讨戒烟的动机和障碍；回顾可用的戒烟支持策略、计划和药物；并确定下一步措施。
在 14 个月的研究期间，有 66516 名成员接受了年度或新患者检查。干预组和对照组的烟草评估（97%）和咨询（93%）率都很高。与对照组（69%比 3%，P<0.01）相比，接受更多椅旁烟草咨询和帮助的干预组患者更有可能接受额外的电话咨询。与对照组相比，干预组患者对牙科团队的控烟工作更满意（P<0.03）。不同员工的转诊率差异很大。
辅助转诊方法成功地融入了常规牙科护理，受到了患者的欢迎，并提高了患者的满意度。由于现在全国范围内都提供免费的基于电话的烟草咨询，因此该方法可能是大多数牙科护理环境的实用策略。
