Danan Elisheva R, Joseph Anne M, Sherman Scott E, Burgess Diana J, Noorbaloochi Siamak, Clothier Barbara, Japuntich Sandra J, Taylor Brent C, Fu Steven S
VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
J Gen Intern Med. 2016 Aug;31(8):878-87. doi: 10.1007/s11606-016-3687-1. Epub 2016 Apr 12.
Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit.
We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit.
Secondary analysis of a multicenter randomized controlled trial.
A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers.
Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines.
Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year.
At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care.
Mostly male participants limits generalizability. Randomization was not stratified by SOC.
Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.
当前指南建议医疗服务提供者评估吸烟者戒烟的意愿，然后为计划戒烟的吸烟者提供戒烟治疗，并为不打算戒烟的吸烟者提供动机干预。
我们研究了改变阶段（SOC）基线、治疗利用情况与戒烟之间的关系，以确定积极戒烟干预的效果是否取决于吸烟者的戒烟动机水平。
一项多中心随机对照试验的二次分析。
来自四个退伍军人事务（VA）医疗中心的总共3006名年龄在18至80岁之间的当前吸烟者。
积极护理包括积极外展（邮寄邀请函后进行电话外展）、提供戒烟服务（电话或面对面）以及获得药物治疗。常规护理参与者可使用VA戒烟服务和州电话戒烟热线。
使用戒烟阶梯量表测量基线SOC，并在1年时自我报告6个月的持续戒烟情况。
在基线时，35.8%的吸烟者处于准备阶段，38.2%处于思考阶段，26.0%处于未思考阶段。SOC与治疗组之间的总体交互作用无统计学意义（p = 0.30）。在准备阶段的吸烟者中，积极护理参与者中有21.1%实现了6个月的持续戒烟，而常规护理参与者中这一比例为13.1%（比值比，1.8 [95%置信区间，1.2 - 2.6]）。同样，积极护理提高了思考阶段吸烟者的戒烟率（11.0%对6.5%；比值比，1.8 [95%置信区间，1.1 - 2.8]）。未思考阶段的吸烟者戒烟率相似（5.3%对5.6%；比值比，0.9 [95%置信区间，0.5 - 1.9]）。在每个阶段，与常规护理相比，随着SOC升高以及积极护理的实施，戒烟治疗的接受度增加。
主要为男性参与者限制了研究结果的普遍性。随机分组未按SOC进行分层。
与常规护理相比，积极护理在所有SOC中均提高了治疗接受度。积极护理提高了准备阶段和思考阶段吸烟者的戒烟率，但未提高未思考阶段吸烟者的戒烟率。向所有SOC的吸烟者主动提供戒烟治疗将提高治疗利用率和人群水平的戒烟率。
