El-Shahawy Omar, Shires Deirdre A, Elston Lafata Jennifer
Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
Eval Health Prof. 2016 Sep;39(3):326-35. doi: 10.1177/0163278715599204. Epub 2015 Aug 18.
Clinical Practice Guidelines for Treating Tobacco Use and Dependence advocate for using counseling targeted at tobacco users' motivation to quit during each office visit. We evaluate tobacco use screening and counseling interventions delivered during routine periodic health examinations by 44 adult primary care physicians practicing in 22 clinics of a large health system in southeast Michigan. 484 office visits were audio-recorded and transcribed. For this study, current tobacco users (N = 91) were identified using pre-visit surveys and audio-recordings. Transcripts were coded for the delivery of tobacco-related counseling interventions. The extent to which counseling interventions were used and/or targeted to the patients' readiness to quit was the main outcome measure. The majority of tobacco users (n = 77) had their tobacco use status assessed, and most received some sort of tobacco-related counseling (n = 74). However, only 15% received the recommended counseling targeted to their readiness to quit. On the other hand, 19% received less counseling than recommended given their readiness to quit, 7% received only nonindicated counseling, and 59% received nonindicated counseling in addition to indicated counseling. Results illustrate physicians' commitment to cessation counseling and also identify potential opportunities to improve the efficiency of tobacco-related counseling in primary care.
《治疗烟草使用与依赖的临床实践指南》提倡在每次门诊就诊时，针对烟草使用者的戒烟动机进行咨询。我们评估了密歇根州东南部一个大型医疗系统的22家诊所中44名成人初级保健医生在定期健康检查期间提供的烟草使用筛查和咨询干预措施。对484次门诊就诊进行了录音和转录。在本研究中，通过就诊前调查和录音确定了当前的烟草使用者（N = 91）。对转录文本进行编码，以统计与烟草相关的咨询干预措施的实施情况。咨询干预措施的使用程度和/或针对患者戒烟意愿的程度是主要的结局指标。大多数烟草使用者（n = 77）的烟草使用状况得到了评估，并且大多数人接受了某种形式的烟草相关咨询（n = 74）。然而，只有15%的人接受了针对其戒烟意愿的推荐咨询。另一方面，19%的人接受的咨询少于根据其戒烟意愿应接受的推荐量，7%的人只接受了非针对性咨询，59%的人除了接受针对性咨询外还接受了非针对性咨询。结果表明了医生对戒烟咨询的重视，同时也确定了提高初级保健中烟草相关咨询效率的潜在机会。
