互动语音电话在促进出院后戒烟中的作用：两项随机临床试验的汇总分析。
Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials.
机构信息
Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
出版信息
J Gen Intern Med. 2017 Sep;32(9):1005-1013. doi: 10.1007/s11606-017-4085-z. Epub 2017 Jun 14.
BACKGROUND
Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge.
OBJECTIVE
To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation.
DESIGN
Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up.
PARTICIPANTS
A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge.
INTERVENTION
After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling.
MAIN MEASURES
Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge.
KEY RESULTS
Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting.
CONCLUSIONS
Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov Identifiers NCT01177176, NCT01714323.
背景
住院为吸烟者提供了戒烟的机会。在医院开始戒烟治疗是有效的，但出院后的治疗维持是一个挑战。带有交互式语音应答（IVR）技术的自动电话可以支持出院后的治疗延续。
目的
评估吸烟者对 IVR 辅助干预的使用情况和满意度，并检验干预剂量与戒烟之间的关系。
设计
对两项具有 6 个月随访的类似随机对照试验的干预组进行汇总的定量和定性数据分析。
参与者
共有 878 名因吸烟相关疾病住院的吸烟者。所有参与者均在医院接受了戒烟咨询，并计划在出院后戒烟。
干预措施
出院后，参与者接受免费戒烟药物和 3 个月内的 5 次自动 IVR 电话。这些电话传递了促进戒烟和药物依从性的信息，提供药物续方，并对吸烟者进行分诊，以便进行额外的电话咨询。
主要措施
回答的 IVR 电话次数、患者满意度、出院后 6 个月经生物化学验证的烟草戒断率。
主要结果
参与者平均回答了 5 次 IVR 电话中的 3 次；70%的人认为这些电话很有帮助，他们提到了社会支持、获得咨询和药物的机会以及戒烟提醒等积极因素。年龄较大的吸烟者（每增加十年，OR 1.36，95%CI 1.20-1.54）和因吸烟相关疾病住院的吸烟者（OR 1.65，95%CI 1.21-2.23）完成的电话次数更多。经过年龄、性别、教育程度、出院诊断、尼古丁依赖程度、药物使用持续时间以及戒烟的重要性和信心的多变量调整后，完成更多电话的吸烟者在 6 个月随访时的戒烟率更高（每多打一个电话，OR 1.49，95%CI 1.30-1.70）。
结论
支持出院后戒烟的自动 IVR 电话受到了患者的好评。更高的 IVR 使用量与 6 个月随访时更高的烟草戒断率相关。IVR 技术为医疗保健系统提供了一种潜在的可扩展方法，用于维持出院后的烟草戒烟干预措施。
临床试验注册
ClinicalTrials.gov 标识符 NCT01177176、NCT01714323。
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