Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21234, USA.
Nicotine Tob Res. 2010 Aug;12(8):797-800. doi: 10.1093/ntr/ntq093. Epub 2010 Jun 11.
Hospitalized smokers benefit from smoking cessation counseling and nicotine replacement therapy (NRT). However, inpatient providers who care for hospitalized patients carry out these preventive measures inconsistently.
We designed a peer-led audit and feedback intervention to improve (a) the frequency of smoking cessation counseling and (b) the appropriateness of the prescribing of NRT by hospitalist practitioners in our hospital. Documentation of tobacco cessation counseling in progress notes and discharge summaries and the ordering and dosing of NRT were assessed for 30 hospitalists before and after an intervention. This intervention included specific feedback on their counseling and prescribing practices as well as education and was delivered as part of a one-on-one academic detailing session.
Five hundred and forty five and 1,119 patient-days were considered for this analysis in the pre- and postperiods, respectively. Documentation of tobacco dependence counseling in progress notes increased from 36% to 44% (p = .002) and from 7.5% to 46.8% in discharge summaries (p < .0001) following the intervention. The appropriateness of NRT dosing increased from 26% (before) to 64% (after) the intervention (p < .0001).
A peer-led audit and feedback intervention for hospitalists significantly increases the frequency of smoking cessation counseling and the adequacy of NRT prescribing for hospitalized smokers.
住院吸烟者受益于戒烟咨询和尼古丁替代疗法（NRT）。然而，照顾住院患者的住院医生在实施这些预防措施时并不一致。
我们设计了一项同行主导的审核和反馈干预措施，以提高（a）戒烟咨询的频率和（b）医院医生开具 NRT 的适当性。在干预前后，对 30 名医院医生的住院记录和出院小结中的烟草戒断咨询记录以及 NRT 的开具和剂量进行了评估。该干预措施包括对其咨询和处方实践的具体反馈以及教育，并作为一对一学术详细讨论的一部分提供。
分别在干预前和干预后考虑了 545 和 1119 个患者日。在干预后，住院记录中烟草依赖咨询记录从 36%增加到 44%（p =.002），从 7.5%增加到 46.8%（p <.0001）。NRT 剂量的适当性从 26%（之前）增加到 64%（之后）（p <.0001）。
针对医院医生的同行主导的审核和反馈干预措施显著提高了戒烟咨询的频率和住院吸烟者使用 NRT 的适当性。
