Joseph Anne M, Fu Steven S, Lindgren Bruce, Rothman Alexander J, Kodl Molly, Lando Harry, Doyle Brandon, Hatsukami Dorothy
Department of Medicine, University of Minnesota, Minneapolis, 55414, USA.
Arch Intern Med. 2011 Nov 28;171(21):1894-900. doi: 10.1001/archinternmed.2011.500.
Tobacco dependence disorder is a chronic relapsing condition, yet treatment is delivered in discrete episodes of care that yield disappointing long-term quit rates.
We conducted a randomized controlled trial from June 1, 2004, through May 31, 2009, to compare telephone-based chronic disease management (1 year; longitudinal care [LC]) with evidence-based treatment (8 weeks; usual care [UC]) for tobacco dependence. A total of 443 smokers each received 5 telephone counseling calls and nicotine replacement therapy by mail for 4 weeks. They were then randomized to UC (2 additional calls) or LC (continued counseling and nicotine replacement therapy for an additional 48 weeks). Longitudinal care targeted repeat quit attempts and interim smoking reduction for relapsers. The primary outcome was 6 months of prolonged abstinence measured at 18 months of follow-up.
At 18 months, 30.2% of LC participants reported 6 months of abstinence from smoking, compared with 23.5% in UC (unadjusted, P = .13). Multivariate analysis showed that LC (adjusted odds ratio, 1.74; 95% CI, 1.08-2.80), quit attempts in past year (1.75; 1.06-2.89), baseline cigarettes per day (0.95; 0.92-0.99), and smoking in the 14- to 21-day interval post-quit (0.23; 0.14-0.38) predicted prolonged abstinence at 18 months. The LC participants who did not quit reduced smoking more than UC participants (significant only at 12 months). The LC participants received more counseling calls than UC participants (mean, 16.5 vs 5.8 calls; P < .001), longer total duration of counseling (283 vs 117 minutes; P < .001), and more nicotine replacement therapy (4.7 vs 2.4 boxes of patches; P < .001).
A chronic disease management approach increases both short- and long-term abstinence from smoking.
clinicaltrials.gov Identifier: NCT00309296.
烟草依赖障碍是一种慢性复发性疾病，但治疗是以离散的护理阶段进行的，长期戒烟率令人失望。
我们于2004年6月1日至2009年5月31日进行了一项随机对照试验，比较基于电话的慢性病管理（1年；纵向护理[LC]）与基于循证治疗（8周；常规护理[UC]）对烟草依赖的效果。共有443名吸烟者每人接受了5次电话咨询，并通过邮件接受了4周的尼古丁替代疗法。然后将他们随机分为接受常规护理组（再增加2次电话咨询）或纵向护理组（继续咨询并再接受48周的尼古丁替代疗法）。纵向护理针对复吸者的重复戒烟尝试和中期减少吸烟量。主要结局是在随访18个月时测量的6个月持续戒烟情况。
在18个月时，纵向护理组中有30.2%的参与者报告戒烟6个月，而常规护理组为23.5%（未调整；P = 0.13）。多变量分析显示，纵向护理（调整后的优势比为1.74；95%可信区间为1.08 - 2.80）、过去一年中的戒烟尝试（1.75；1.06 - 2.89）、基线每日吸烟量（0.95；0.92 - 0.99）以及戒烟后14至21天内的吸烟情况（0.23；0.14 - 0.38）可预测18个月时的持续戒烟情况。未戒烟的纵向护理组参与者比常规护理组参与者吸烟量减少更多（仅在12个月时具有显著性）。纵向护理组参与者比常规护理组参与者接受的咨询电话更多（平均分别为16.5次和5.8次；P < 0.001），咨询总时长更长（分别为283分钟和117分钟；P < 0.001），接受的尼古丁替代疗法更多（分别为4.7盒贴片和2.4盒贴片；P < 0.001）。
慢性病管理方法可提高短期和长期的戒烟率。
clinicaltrials.gov标识符：NCT00309296 。
