Center for Health and Public Policy Studies, University of California, Berkeley, 94720-7360, USA.
Am J Prev Med. 2010 Nov;39(5):449-56. doi: 10.1016/j.amepre.2010.07.009.
There remains an ongoing need to reduce tobacco use in the U.S. Physician organizations, such as medical groups, can support healthcare providers to be more effective in their delivery of tobacco cessation by adopting practices recommended in the Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (PHS Guideline).
To document the extent to which activities to reduce tobacco use, as recommended in the PHS Guideline as system-level interventions, are provided within large medical groups in the U.S.
During 2006-2007, data were collected on 339 medical groups operating in the U.S., with 20 or more physicians treating at least one of four chronic conditions. Organizations were surveyed regarding activities to reduce tobacco use as recommended in the PHS Guideline as system-level interventions (i.e., tobacco-use status documentation, policies to promote provider interventions, and staff dedicated to treating tobacco dependence). Between 2008 and 2009, bivariate associations and multivariate logistic regression models assessed the relationship of organizational characteristics and external incentives with adoption of systems strategies for treating tobacco dependence.
Nearly 83% of medical groups with 20 or more physicians operating in the U.S. in 2006-2007 have adopted one or more strategies recommended as effective to support the treatment of tobacco dependence. However, only 5.6% of medical groups engage in all eight tobacco control activities examined in this study. The two factors that were associated most consistently with medical group policies to treat tobacco dependence were the patient-centeredness of the organization and participation in a quality demonstration program.
There is much room for improvement in increasing medical group adoption of systems strategies to reduce tobacco use. The findings in this paper suggest recommendations to achieve these improvements.
美国仍需要持续减少烟草使用。医生组织（如医疗集团）可以通过采用《公共卫生服务治疗烟草使用和依赖临床实践指南》（PHS 指南）中推荐的实践来支持医疗保健提供者更有效地实施烟草戒断，从而为他们提供支持。
记录在美国大型医疗集团中提供减少烟草使用的活动的程度，这些活动是按照 PHS 指南中的系统干预措施建议进行的。
在 2006-2007 年期间，收集了美国 339 个运营的医疗集团的数据，这些集团拥有 20 名或更多治疗至少四种慢性疾病的医生。对这些组织进行了关于减少烟草使用的调查，这些活动是按照 PHS 指南中的系统干预措施建议进行的（即烟草使用状况记录、促进提供者干预的政策以及专门治疗烟草依赖的工作人员）。在 2008 年至 2009 年期间，采用双变量关联和多变量逻辑回归模型评估了组织特征和外部激励措施与采用治疗烟草依赖的系统策略之间的关系。
2006-2007 年在美国拥有 20 名或更多医生的医疗集团中，近 83%的集团已经采用了一种或多种被认为有效的策略来支持治疗烟草依赖。然而，只有 5.6%的医疗集团参与了本研究中检查的所有八项烟草控制活动。与医疗集团治疗烟草依赖政策最相关的两个因素是组织的以患者为中心和参与质量示范项目。
在增加医疗集团采用减少烟草使用的系统策略方面还有很大的改进空间。本文的研究结果提出了实现这些改进的建议。
