University Medical Centre Göttingen, Göttingen, Germany University College London, London, UK
University Medical Centre Göttingen, Göttingen, Germany.
Eur J Prev Cardiol. 2014 Jul;21(7):915-22. doi: 10.1177/2047487312462803. Epub 2012 Sep 24.
Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers.
Prospective intervention study followed by qualitative analysis of staff interviews.
The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity.
A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p < 0.001) and 2.7% (p = 0.56), respectively. Qualitative analysis revealed that lack of motivation, e.g. role incongruence, appeared to be a major barrier.
Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed.
吸烟是心血管疾病的主要危险因素，心血管疾病患者必须戒烟。本研究旨在评估一种基于系统的方法，以帮助住院吸烟者戒烟，并确定实施障碍。
前瞻性干预研究，随后对员工访谈进行定性分析。
前瞻性干预研究评估了在心脏病病房为吸烟者提供咨询和药物治疗的标准操作程序（SOPs）实施对咨询频率的影响。此外，还进行了员工访谈的定性分析，以检查医生和护士行为的决定因素；这旨在从动机、能力和/或机会方面理解障碍。
共有 150 名吸烟患者纳入研究（SOP 实施前 75 名，实施后 75 名）。在实施 SOP 之前，报告接受医生和护士戒烟咨询的患者比例分别为 6.7%和 1.3%。实施 SOP 后，这两个比例分别增加到 38.7%（p<0.001）和 2.7%（p=0.56）。定性分析表明，缺乏动机，例如角色不一致，似乎是一个主要障碍。
引入一套戒烟咨询标准操作程序对医生有效，但对护士无效。对实施障碍的分析强调，缺乏动机而不是能力或机会是需要解决的主要因素。
