Ridner S Lee, Ostapchuk Michael, Cloud Richard N, Myers John, Jorayeva Anna, Ling Jiying
From the University of Louisville School of Nursing, Family Medicine, Kent School of Social Work, Department of Pediatrics, Louisville, Kentucky.
South Med J. 2014 May;107(5):314-9. doi: 10.1097/SMJ.0000000000000106.
To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach--ask, advise, assess, assist, and arrange follow-up (5 As)--on current smokers' behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence.
The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit.
There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores.
Resident physicians who use MI techniques have a tremendous effect on patients' smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.
比较住院医师动机性访谈（MI）、住院医师MI联合注册护士（RN）以及标准护理咨询方法——询问、建议、评估、协助和安排随访（5A法）对当前吸烟者行为（戒烟意愿、每日吸烟量、当前吸烟率）、戒烟自我效能以及尼古丁依赖的影响。
本研究设计为准实验性的前测/后测并设对照组。在基线时于诊所环境中完成纸笔测量，并在诊所就诊后约1个月和2个月通过电话进行测量。
三组中戒烟参与者的比例无差异，且改变阶段在组间或随时间均无差异。存在显著的时间效应，且每日吸烟量减少（F2,160 = 41.04，P < 0.001）。自我效能（F4,140 = 8.20，P < 0.001）、尼古丁依赖（F4,140 = 6.22，P < 0.001）以及对临床医生的满意度（F4,160 = 3.81，P = 0.006）存在显著的组×时间交互作用。事后分析表明，MI组的参与者吸烟量更少，自我效能更高，尼古丁依赖得分更低。只有MD加RN随访组的参与者满意度得分有显著的正向变化。
使用MI技术的住院医师对患者的吸烟行为有巨大影响。当住院医师和RN共同协作时，参与者能取得更好的结果。
