Duffy Sonia A, Ronis David L, Ewing Lee A, Waltje Andrea H, Hall Stephanie V, Thomas Patricia L, Olree Christine M, Maguire Kimberly A, Friedman Lisa, Klotz Sue, Jordan Neil, Landstrom Gay L
College of Nursing, Ohio State University, Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, USA.
Veterans Affairs (VA) Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Implement Sci. 2016 Nov 4;11(1):147. doi: 10.1186/s13012-016-0511-6.
Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.
This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).
Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training.
Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive ("user friendly," "streamlined," or "saves time"), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.
Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation.
ClinicalTrials.gov, NCT01309217.
在“普及、效果、采用、实施和维持”（RE-AIM）实施框架的指导下，一项由美国国立卫生研究院资助的研究将护士实施的“烟草策略”干预措施与常规护理进行了比较。之前的一篇论文描述了“烟草策略”干预措施的效果。这篇后续论文提供了描述RE-AIM框架其余构成部分的数据。
这项实用研究采用了混合方法、准实验设计，在密歇根州的五家社区医院进行，其中三家接受了护士实施的“烟草策略”干预措施，两家接受常规护理。在干预前后对护士和患者进行了调查。测量指标包括普及情况（患者参与率、特征和服务接受情况）、采用情况（护士参与率和特征）、实施情况（培训前后护士态度的变化、服务提供情况、实施障碍、对培训的看法、服务记录以及志愿者跟进电话数量）和维持情况（研究结束后干预措施的持续实施）。
普及情况：患者参与率为71.5%。与对照组无变化相比，干预医院中自我报告收到印刷材料的情况在干预前后有显著增加（n = 1370，p < 0.001）。采用情况：在干预医院中，所有目标科室和几个非目标科室都参与了；76.0%（n = 1028）的目标护士和另外317名工作人员参加了培训，92.4%的人对培训非常满意或比较满意。
干预医院的护士报告在提供戒烟建议、咨询、药物、宣传资料和DVD方面有所增加（所有p < 0.05），并报告实施戒烟服务的障碍有所减少（p < 0.001）。定性评论非常积极（“用户友好”“简化”或“节省时间”），不过也指出了在向患者展示DVD和在电子病历中记录方面存在的问题。维持情况：研究结束后护士继续提供干预措施。
鉴于护士是最大的一线医疗服务提供者群体，这项符合联合委员会治疗住院吸烟者指南的干预措施有可能广泛实施，并降低住院吸烟者的吸烟率、发病率和死亡率。随着我们朝着更多基于人群的干预措施发展，RE-AIM框架是实施过程中的宝贵指南。
ClinicalTrials.gov，NCT01309217。
