Ragucci Kelly R, Shrader Sarah P
Clinical Pharmacy and Outcome Sciences/Family Medicine, Associate Graduate Pharmacy Education, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC 29425, USA.
Ann Pharmacother. 2009 Oct;43(10):1616-20. doi: 10.1345/aph.1M301. Epub 2009 Sep 8.
Published evidence demonstrates benefit from pharmacist smoking cessation interventions; however, there is limited research evaluating the impact of a template within an electronic medical record used at pharmacy disease state management visits.
To determine the rates of smoking cessation and movement along the transtheoretical model of change after implementation of a template into existing pharmacy-related progress notes within the electronic medical record.
Patients who were routinely followed by clinical pharmacists for anticoagulation and diabetes mellitus education at 3 clinics at the Medical University of South Carolina were included. At each visit, the pharmacist would document patient smoking information in a newly designed template within the existing progress note. In addition, pharmacists would educate patients on the benefits of smoking cessation and pharmacologic options that may be available to them. Data were collected between April 2007 and March 2008. Baseline demographic data and smoking cessation rates and products were compared using descriptive statistics. The McNemar chi(2) test was used to compare the groups of patients achieving smoking cessation pre- and postintervention.
Of the 90 current smokers, 38 (42%) achieved smoking cessation postintervention. Movement along the transtheoretical model of change was also seen, with 52 (58%) patients progressing to at least the next stage. Thirty-four patients in the contemplation/preparation stage and 4 patients in the precontemplation stage moved to the action or maintenance stage by the end of the study period (p = 0.03). A variety of pharmacologic therapies were used in individuals who stopped smoking, although varenicline was most common. Thirty-nine percent of the patients used no medications to achieve cessation.
Incorporating a smoking cessation template into existing progress notes and providing education during existing pharmacy referral visits is a simple and effective method to assist patients in achieving smoking cessation.
已发表的证据表明药剂师戒烟干预措施具有益处；然而，评估电子病历中的模板在药房疾病状态管理就诊中的影响的研究有限。
确定在电子病历中现有的药房相关病程记录中实施模板后，戒烟率以及沿跨理论模型变化的进展情况。
纳入南卡罗来纳医科大学3家诊所中由临床药剂师定期随访进行抗凝和糖尿病教育的患者。每次就诊时，药剂师会在现有病程记录中新设计的模板中记录患者吸烟信息。此外，药剂师会向患者宣传戒烟的益处以及他们可能可用的药物选择。数据收集于2007年4月至2008年3月之间。使用描述性统计比较基线人口统计学数据、戒烟率和戒烟产品。采用McNemar卡方检验比较干预前后实现戒烟的患者组。
在90名当前吸烟者中，38名（42%）在干预后实现了戒烟。沿跨理论模型变化也有进展，52名（58%）患者至少进展到下一个阶段。到研究期结束时，34名处于思考/准备阶段的患者和4名处于前思考阶段的患者进入了行动或维持阶段（p = 0.03）。戒烟的个体使用了多种药物疗法，尽管伐尼克兰最为常见。39%的患者未使用药物实现戒烟。
将戒烟模板纳入现有的病程记录并在现有的药房转诊就诊期间提供教育是帮助患者实现戒烟的一种简单有效的方法。
