退出一般实践：一项增强实践中戒烟支持的随机对照试验。
Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation.
机构信息
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
出版信息
BMC Fam Pract. 2010 Aug 12;11:59. doi: 10.1186/1471-2296-11-59.
BACKGROUND
This study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients.
METHODS/DESIGN: This study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study and the process of written referral and GPs in the usual care group will receive information about the study. Eligible patients are those aged 18 and over presenting to their GP who are daily or weekly smokers and who are able to give informed consent. Patients on low incomes in all three groups will be able to access free nicotine patches.Primary outcomes are sustained abstinence and point prevalence abstinence at the three month and 12 month follow-up points; and incremental cost effectiveness ratios at 12 months. Process evaluation on the reach and acceptability of the intervention approached will be collected through Computer Assisted Telephone Interviews (CATI) with patients and semi-structured interviews with PNs and GPs.The primary analysis will be by intention to treat. Cessation outcomes will be compared between the three arms at three months and 12 month follow-up using multiple logistic regression. The incremental cost effectiveness ratios will be estimated for the 12 month quit rate for the intervention groups compared to usual care and to each other. Analysis of qualitative data on process outcomes will be based on thematic analysis.
DISCUSSION
High quality evidence on effectiveness of practice nurse interventions is needed to inform health policy on development of practice nurse roles. If effective, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice.
TRIAL REGISTRATION
ACTRN12609001040257.
背景
本研究将测试主要由执业护士（PN）提供的灵活戒烟支持包的接受程度和有效性，并根据患者的需求进行调整。
方法/设计：这是一项群组随机试验，将诊所分配到以下三个组之一：1）与执业护士一起戒烟；2）戒烟热线转介；3）GP 常规护理。随机分配到干预组的 PN 将接受戒烟培训课程，然后获得指导。随机分配到戒烟热线转介组的 GP 将获得有关该研究的信息和书面转介过程，而常规护理组的 GP 将获得有关该研究的信息。符合条件的患者是年龄在 18 岁及以上，向其 GP 就诊的患者，他们是每天或每周吸烟的人，并且能够给予知情同意。所有三组中收入较低的患者都可以免费获得尼古丁贴片。主要结果是在三个月和十二个月随访时的持续戒烟和点患病率戒烟，以及十二个月时的增量成本效益比。通过对患者进行计算机辅助电话访谈（CATI）和对 PN 和 GP 进行半结构化访谈，收集对干预措施的可达性和可接受性的过程评估。主要分析将采用意向治疗进行。使用多因素逻辑回归比较三个月和十二个月随访时三组之间的戒烟结局。干预组与常规护理组和彼此之间的十二个月戒烟率的增量成本效益比将进行估计。基于主题分析对定性数据进行分析。
讨论
需要高质量的实践护士干预措施有效性证据，以为实践护士角色发展的卫生政策提供信息。如果有效，PN 与 GP 和戒烟热线合作提供灵活的支持可能成为澳大利亚普通实践中提供戒烟建议的首选模式。
试验注册
ACTRN12609001040257。
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