Brown Clayton H, Medoff Deborah, Dickerson Faith B, Fang Li Juan, Lucksted Alicia, Goldberg Richard W, Kreyenbuhl Julie, Himelhoch Seth, Dixon Lisa B
J Dual Diagn. 2015;11(2):145-50. doi: 10.1080/15504263.2015.1025025.
Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidence-based "5 A's" (ask, advise, assess, assist, arrange) in six community mental health centers in greater Baltimore.
Data collected as part of a larger study examining the effectiveness of delivery of the 5 A's at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5 A's. Second, we used multilevel models to examine variance between patients (n = 228), patient factors, and variance between their psychiatrists (n = 28) in the delivery of the 5 A's (and first 3 A's).
The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5 A's and 3 A's. Patient "readiness to change" predicted delivery of the full 5 A's, while smoking severity predicted delivery of the first 3 A's.
There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidence-based smoking cessation treatment in the mental health care setting.
患有严重精神疾病的消费者吸烟更多，且患与吸烟相关疾病的风险更高。我们研究了影响巴尔的摩大区六家社区心理健康中心实施循证“5A法”（询问、建议、评估、协助、安排）的提供者和消费者因素。
作为一项关于在患者就诊时实施5A法有效性的更大规模研究的一部分收集数据。首先，我们研究了对49名临床医生进行的关于实施5A法的障碍和态度的调查的回复。其次，我们使用多层次模型来研究患者（n = 228）、患者因素以及他们的精神科医生（n = 28）在实施5A法（以及前3个A）方面的差异。
最强烈认可的障碍是认为患者对戒烟缺乏兴趣。精神科医生和患者在实施5A法和3A法方面均导致了显著差异。患者“改变的意愿”预测了完整5A法的实施，而吸烟严重程度预测了前3个A的实施。
迫切需要创造性的合作解决方案、政策和临床医生培训，以解决在精神卫生保健环境中实施循证戒烟治疗的实际和感知障碍。
