Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, 3780 Eisenhower Pkwy, Macon, GA 31206, USA.
BMC Fam Pract. 2010 Mar 5;11:18. doi: 10.1186/1471-2296-11-18.
Though screening and intervention for alcohol and tobacco misuse are effective, primary care screening and intervention rates remain low. Previous studies have increased intervention rates using vital signs screening for tobacco misuse and clinician prompts for screen-positive patients for both alcohol and tobacco misuse. This pilot study's aims were: (1) To determine the feasibility of combined vital signs screening for tobacco and alcohol misuse, (2) To assess the impact of vital signs screening on alcohol and tobacco screening and intervention rates, and (3) To assess the additional impact of tobacco assessment prompts on intervention rates.
In five outpatient practices, nurses measuring vital signs were trained to routinely ask a single tobacco question, a prescreening question that identified current drinkers, and the single alcohol screening question for current drinkers. After 4-8 weeks, clinicians were trained in tobacco intervention and nurses were trained to give tobacco abusers a tobacco questionnaire which also served as a clinician intervention prompt. Screening and intervention rates were measured using patient exit interviews (n = 622) at baseline, during the "screening only" period, and during the tobacco prompting phase. Changes in screening and intervention rates were compared using chi square analyses and test of linear trends. Clinic staff were interviewed regarding patient and staff acceptability. Logistic regression was used to evaluate the impact of nurse screening on clinician intervention, the impact of alcohol intervention on concurrent tobacco intervention, and the impact of tobacco intervention on concurrent alcohol intervention.
Alcohol and tobacco screening rates and alcohol intervention rates increased after implementing vital signs screening (p < .05). During the tobacco prompting phase, clinician intervention rates increased significantly for both alcohol (12.4%, p < .001) and tobacco (47.4%, p = .042). Screening by nurses was associated with clinician advice to reduce alcohol use (OR 13.1; 95% CI 6.2-27.6) and tobacco use (OR 2.6; 95% CI 1.3-5.2). Acceptability was high with nurses and patients.
Vital signs screening can be incorporated in primary care and increases alcohol screening and intervention rates. Tobacco assessment prompts increase both alcohol and tobacco interventions. These simple interventions show promise for dissemination in primary care settings.
尽管筛查和干预酒精和烟草滥用是有效的，但初级保健的筛查和干预率仍然很低。先前的研究已经通过对烟草滥用的生命体征筛查和对酒精和烟草滥用筛查阳性患者的临床医生提示来提高干预率。本试点研究的目的是：（1）确定联合生命体征筛查烟草和酒精滥用的可行性，（2）评估生命体征筛查对酒精和烟草筛查和干预率的影响，以及（3）评估烟草评估提示对干预率的额外影响。
在五家门诊诊所，测量生命体征的护士接受了常规询问单一烟草问题、识别当前饮酒者的预筛查问题以及当前饮酒者单一酒精筛查问题的培训。在 4-8 周后，临床医生接受了烟草干预培训，护士接受了为烟草使用者提供烟草问卷的培训，该问卷也充当临床医生干预提示。在基线、“仅筛查”期间和烟草提示阶段，使用患者出口访谈（n=622）测量筛查和干预率。使用卡方分析和线性趋势检验比较筛查和干预率的变化。对患者和工作人员的可接受性进行了诊所工作人员的访谈。使用逻辑回归评估护士筛查对临床医生干预的影响、酒精干预对同时进行的烟草干预的影响以及烟草干预对同时进行的酒精干预的影响。
实施生命体征筛查后，酒精和烟草筛查率以及酒精干预率均有所提高（p<0.05）。在烟草提示阶段，临床医生对酒精（12.4%，p<0.001）和烟草（47.4%，p=0.042）的干预率显著增加。护士的筛查与临床医生减少酒精使用的建议相关（OR 13.1；95%CI 6.2-27.6）和烟草使用（OR 2.6；95%CI 1.3-5.2）。护士和患者的接受度都很高。
生命体征筛查可纳入初级保健，并提高酒精筛查和干预率。烟草评估提示增加了酒精和烟草的干预。这些简单的干预措施为在初级保健环境中传播提供了希望。
