Wolfenden Luke, Wiggers John, Campbell Elizabeth, Knight Jenny, Kerridge Ross, Spigelman Allan
Hunter New England Population Health, Newcastle, Australia.
Drug Alcohol Rev. 2009 Jan;28(1):60-5. doi: 10.1111/j.1465-3362.2008.00003.x.
The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision.
Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care.
The computer-based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support.
The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.
在手术患者入院前提供戒烟护理可减少术后并发症，并促进长期戒烟。我们的目的是展示一种为加强对手术患者的戒烟护理而开发的全面的计算机辅助戒烟干预措施如何克服护理提供方面的障碍。
与术前门诊工作人员进行了咨询，并对科学文献进行了综述，确定了提供有效戒烟护理的以下障碍：缺乏组织支持、认为患者会反对、缺乏识别吸烟者的系统、工作人员时间和技能不足、认为无法改变护理做法、认为戒烟护理缺乏效果以及提供护理的成本。基于一项试点试验的积极结果，在术前门诊实施了一项全面的计算机辅助戒烟干预措施。干预措施先前评估的数据用于评估该干预措施在多大程度上克服了临床医生在护理方面的障碍。
发现基于计算机的干预措施提供了一种准确且系统地识别吸烟者的方法；它几乎不需要临床工作人员的时间或技能；工作人员和患者认为它是一种可接受的护理形式；它在鼓励患者戒烟方面有效，并且相对于其他手术成本而言实施成本较低。此外，在没有持续研究支持的情况下，基于计算机的干预措施仍在术前门诊继续实施。
有兴趣降低患者吸烟相关发病率和死亡率的临床服务机构应考虑实施这种护理模式。
