UK Centre for Tobacco Control Studies, University of Bath, Bath, United Kingdom.
Nicotine Tob Res. 2012 Jun;14(6):703-10. doi: 10.1093/ntr/ntr271. Epub 2011 Dec 21.
General practice is a recommended setting for the delivery of smoking cessation programs. Little is known about the types of practice that achieve higher cessation rates. To address this gap in knowledge, we assessed the impact of general practice characteristics on the outcomes of a large scale smoking cessation intervention delivered in general practice settings.
A cross-sectional study was undertaken of 7,778 participants enrolled on a structured cessation program comprising repeated brief interventions in one-to-one sessions and nicotine replacement therapy in Christchurch New Zealand, 2001-2007. We employed a logistic multilevel analysis of respondents nested in general practices with cessation at 6 months as the outcome measure.
After taking into account relevant individual-level predictors (age, sex, smoking intensity) and area-level surrogates for individual predictors (socioeconomic status and access to tobacco retail outlets), there remained significant variation in quit rates between practices. This variation reduced when practice characteristics were included. Practices with a majority of male doctors and practices with fewer male patients were associated with better quit rates. Practices with large numbers of doctors were less effective in achieving cessation with heavy smokers.
The effectiveness of smoking cessation programs can be influenced significantly by practice characteristics. To increase quit rates, more attention should be paid to the institutional setting of smoking cessation programs. Assessments of the effectiveness of cessation programs should give appropriate recognition to the fact that some practices may find higher quit rates more difficult to achieve.
一般实践是推荐的戒烟计划实施场所。对于哪些实践类型能实现更高的戒烟率，我们知之甚少。为了弥补这方面知识的不足，我们评估了一般实践特征对在一般实践环境中实施的大规模戒烟干预措施的结果的影响。
这是一项横断面研究，对 2001-2007 年在新西兰克赖斯特彻奇参加包括一对一会议中重复进行简短干预和尼古丁替代疗法的结构化戒烟计划的 7778 名参与者进行了研究。我们采用逻辑多水平分析方法，将受访者嵌套在一般实践中，以 6 个月的戒烟率作为衡量结果。
在考虑了相关的个体水平预测因素（年龄、性别、吸烟强度）和个体预测因素的区域水平替代指标（社会经济地位和获得烟草零售点的机会）后，实践之间的戒烟率仍然存在显著差异。当包括实践特征时，这种差异会减少。男性医生占多数的实践和男性患者较少的实践与更高的戒烟率相关。医生人数较多的实践在使重度吸烟者戒烟方面效果较差。
戒烟计划的有效性可以受到实践特征的显著影响。为了提高戒烟率，应更加关注戒烟计划的制度环境。对戒烟计划的有效性进行评估时，应适当认识到一些实践可能更难实现更高的戒烟率这一事实。
