Bickerstaffe Gary
Bolton Council Public Health & Bolton NHS Foundation Trust.
BMJ Qual Improv Rep. 2014 Jul 18;3(1). doi: 10.1136/bmjquality.u204964.w2110. eCollection 2014.
People who smoke make up a significant number of those admitted to hospital (NICE 2014). Being admitted to hospital can present a unique opportunity to attempt to stop smoking. Many smokers find quitting very difficult (Rigotti et al 2007), in large part due to them living and working in environments that contain many cues and triggers associated with nicotine consumption and smoking behaviours. Hospitals generally do not contain such environmental prompts to smoke. In the community, smokers have access to numerous types of support including GP's, pharmacies and Stop Smoking Services (SSS). Once admitted to hospital access to such support is significantly diminished. Given that many patients may be highly motivated to attempt to stop smoking due to heightened concerns about their health and being in an environment not associated with their smoking habits, it seems prudent to ensure there is access to all the levels of smoking cessation support available outside of the hospital. Not providing such support neglects implementing an evidence based, cost-effective health intervention in a major health setting (NICE 2014). A SSS pathway was designed that enabled existing hospital healthcare staff to be trained to identify patients that smoke, ask if the patient is considering quitting or abstaining whilst in hospital. If motivated to quit or abstain, to complete an assessment. This being based around dependence to nicotine and motivation to quit. Access to all available stop smoking medications should be included. Medication should only be provided alongside some level of motivational support up to discharge. Training core staff was felt to be the best option. They are available outside of office hours and access hospital systems such as pharmacy more readily than satellite staff. On discharge the patient is 'handed over' to SSS for continued contact and support once at home. Over 200 staff are trained to complete the assessment and support inpatients to stop or abstain. Approximately 30-35 referrals are made to the local SSS each month, the quit rate at 4 weeks averaging around 40-45%. Most referrals are seen from cardiology and respiratory. All hospital departments should identify staff to be trained to offer cessation support to their patients .
吸烟人群占住院患者的很大比例（英国国家卫生与临床优化研究所，2014年）。住院为尝试戒烟提供了一个独特的契机。许多吸烟者发现戒烟非常困难（里戈蒂等人，2007年），很大程度上是因为他们生活和工作的环境中存在许多与尼古丁摄入及吸烟行为相关的线索和诱因。医院通常不存在此类吸烟的环境诱因。在社区，吸烟者可获得多种类型的支持，包括家庭医生、药房及戒烟服务机构。一旦住院，此类支持的可及性会大幅降低。鉴于许多患者可能因对自身健康的高度关注以及身处与吸烟习惯无关的环境中而有强烈的戒烟意愿，确保患者能获得医院外所有层面的戒烟支持似乎是明智之举。不提供此类支持忽视了在主要医疗环境中实施一项基于证据且具成本效益的健康干预措施（英国国家卫生与临床优化研究所，2014年）。设计了一条戒烟服务途径，使现有的医院医护人员接受培训，以识别吸烟患者，询问患者在住院期间是否考虑戒烟或戒断。若有戒烟意愿，进行评估。评估围绕对尼古丁的依赖程度和戒烟动机展开。应包括提供所有可用的戒烟药物。药物应仅在一定程度的动机支持下提供，直至出院。培训核心工作人员被认为是最佳选择。他们在办公时间之外也能提供服务，且比外派工作人员更易进入医院系统，如药房。出院时，患者被“交接”给戒烟服务机构，以便在家中能持续获得联系和支持。200多名工作人员接受了培训，以完成评估并支持住院患者戒烟或戒断。每月约有30 - 35例被转诊至当地戒烟服务机构，四周的戒烟率平均约为40 - 45%。大多数转诊患者来自心血管科和呼吸科。所有医院科室都应确定接受培训的工作人员，以便为患者提供戒烟支持。
