Tilert Timothy J, Chen Jie
Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland.
Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
Am J Prev Med. 2015 Jun;48(6):683-93. doi: 10.1016/j.amepre.2014.11.016.
Smoking cessation is the most effective therapeutic intervention for chronic obstructive pulmonary disease (COPD) patients. However, the proportion of smokers with COPD who have received physician advice to quit smoking is unknown. The purpose of this study is to assess the prevalence of receipt of smoking-cessation advice among adults with COPD and explore factors predicting advice receipt.
This study employed nationally representative data from the Medical Expenditure Panel Survey (MEPS), collected in 2008-2011 on adults aged ≥20 years. Logistic regression models were conducted to estimate the likelihood of receiving provider advice. Data were analyzed in 2014.
Four percent (95% CI=3.8%, 4.2%) of adults reported being diagnosed with COPD. Among them, 38.5% (95% CI=36.1%, 40.8%) were current smokers. Among those who had seen a physician in the past year, 85.6% (95% CI=83.1%, 88.0%) were advised to quit smoking. Logistic regression revealed negative associations between receipt of smoking-cessation advice and having fewer healthcare visits (AOR=0.41, 95% CI=0.23, 0.72); being uninsured (AOR=0.43, 95% CI=0.22, 0.83); having no usual source of care (AOR=0.39, 95% CI=0.19, 0.80); and having no comorbid chronic diseases (AOR=0.50, 95% CI=0.29, 0.85).
Having no usual source of care and no health insurance are major barriers to receiving smoking-cessation advice among patients with COPD. The Patient Protection and Affordable Care Act has the potential to increase advice receipt in this high-risk population by expanding health insurance coverage and increasing the number of people with a usual source of care.
戒烟是慢性阻塞性肺疾病（COPD）患者最有效的治疗干预措施。然而，接受医生戒烟建议的慢性阻塞性肺疾病吸烟者的比例尚不清楚。本研究的目的是评估慢性阻塞性肺疾病成人患者接受戒烟建议的患病率，并探讨预测建议接受情况的因素。
本研究采用了医疗支出面板调查（MEPS）中具有全国代表性的数据，该数据于2008 - 2011年收集，涉及年龄≥20岁的成年人。进行逻辑回归模型以估计接受提供者建议的可能性。数据于2014年进行分析。
4%（95%置信区间=3.8%，4.2%）的成年人报告被诊断患有慢性阻塞性肺疾病。其中，38.5%（95%置信区间=36.1%，40.8%）为当前吸烟者。在过去一年看过医生的人中，85.6%（95%置信区间=83.1%，88.0%）被建议戒烟。逻辑回归显示，接受戒烟建议与医疗就诊次数较少（比值比=0.41，95%置信区间=0.23，0.72）、未参保（比值比=0.43，95%置信区间=0.22，0.83）、没有固定的医疗服务来源（比值比=0.39，95%置信区间=0.19，0.80）以及没有合并慢性疾病（比值比=0.50，95%置信区间=0.29，0.85）之间存在负相关。
没有固定的医疗服务来源和没有医疗保险是慢性阻塞性肺疾病患者接受戒烟建议的主要障碍。《患者保护与平价医疗法案》有可能通过扩大医疗保险覆盖范围和增加有固定医疗服务来源人群的数量，提高这一高危人群接受建议的比例。
