Hardy Bethany, Szatkowski Lisa, Tata Laila J, Coleman Tim, Dhalwani Nafeesa N
Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1 PB, UK.
BMC Fam Pract. 2014 Feb 1;15:21. doi: 10.1186/1471-2296-15-21.
United Kingdom (UK) national guidelines recommend that all pregnant women who smoke should be advised to quit at every available opportunity, and brief cessation advice is an efficient and cost-effective means to increase quit rates. The Quality and Outcomes Framework (QOF) implemented in 2004 requires general practitioners to document their delivery of smoking cessation advice in patient records. However, no specific targets have been set in QOF for the recording of this advice in pregnant women. We used a large electronic primary care database from the UK to quantify the pregnancies in which women who smoked were recorded to have been given smoking cessation advice, and the associated maternal characteristics.
Using The Health Improvement Network database we calculated annual proportions of pregnant smokers between 2000 and 2009 with cessation advice documented in their medical records during pregnancy. Logistic regression was used to assess variation in the recording of cessation advice with maternal characteristics.
Among 45,296 pregnancies in women who smoked, recorded cessation advice increased from 7% in 2000 to 37% in 2004 when the QOF was introduced and reduced slightly to 30% in 2009. Pregnant smokers from the youngest age group (15-19) were 21% more likely to have a record of cessation advice compared to pregnant smokers aged 25-29 (OR 1.21, 95% CI 1.10-1.35) and pregnant smokers from the most deprived group were 38% more likely to have a record for cessation advice compared to pregnant smokers from the least deprived group (OR 1.38, 95% CI 1.14-1.68). Pregnant smokers with asthma were twice as likely to have documentation of cessation advice in their primary care records compared to pregnant smokers without asthma (OR 1.97, 95% CI 1.80-2.16). Presence of comorbidities such as diabetes, hypertension and mental illness also increased the likelihood of having smoking cessation advice recorded. No marked variations were observed in the recording of cessation advice with body mass index.
Recorded delivery of smoking cessation advice for pregnant smokers in primary care has increased with some fluctuation over the years, especially after the implementation of the QOF, and varies with maternal characteristics.
英国国家指南建议，应建议所有吸烟的孕妇抓住一切机会戒烟，简短的戒烟建议是提高戒烟率的一种有效且具成本效益的方法。2004年实施的质量与结果框架（QOF）要求全科医生在患者记录中记录他们提供的戒烟建议。然而，QOF中并未为记录向孕妇提供的此类建议设定具体目标。我们使用了来自英国的一个大型电子初级保健数据库，以量化记录有向吸烟女性提供戒烟建议的妊娠情况以及相关的孕产妇特征。
利用健康改善网络数据库，我们计算了2000年至2009年期间在孕期医疗记录中有戒烟建议记录的吸烟孕妇的年度比例。使用逻辑回归评估戒烟建议记录情况随孕产妇特征的变化。
在45296例吸烟女性的妊娠中，有记录的戒烟建议从2000年的7%增至2004年（引入QOF时）的37%，并在2009年略有降至30%。年龄最小组（15 - 19岁）的吸烟孕妇有戒烟建议记录的可能性比25 - 29岁的吸烟孕妇高21%（比值比1.21，95%置信区间1.10 - 1.35），最贫困组的吸烟孕妇有戒烟建议记录的可能性比最不贫困组的吸烟孕妇高38%（比值比1.38，95%置信区间1.14 - 1.68）。患有哮喘的吸烟孕妇在其初级保健记录中有戒烟建议记录的可能性是未患哮喘的吸烟孕妇的两倍（比值比1.97，95%置信区间1.80 - 2.16）。存在糖尿病、高血压和精神疾病等合并症也增加了有戒烟建议记录的可能性。在戒烟建议记录方面，未观察到与体重指数有明显差异。
多年来，初级保健中记录的向吸烟孕妇提供戒烟建议的情况有所增加，虽有一些波动，尤其是在实施QOF之后，且随孕产妇特征而有所不同。
