New York University School of Medicine, Department of Population Health, New York, NY, USA.
VA New York Harbor Healthcare System, New York, NY.
Nicotine Tob Res. 2018 Sep 4;20(10):1223-1230. doi: 10.1093/ntr/ntx204.
Veterans with mental health disorders smoke at high rates, but encounter low rates of tobacco treatment. We sought to understand barriers and facilitators to treating tobacco use in VA mental health clinics.
This qualitative study was part of a trial evaluating a telephone care coordination program for smokers using mental health services at six VA facilities. We conducted semi-structured interviews with 14 staff: 12 mental health clinic staff working at the parent study's intervention sites (n = 6 psychiatrists, three psychologists, two social workers, one NP), as well as one psychiatrist and one psychologist on the VA's national tobacco advisory committee. Interviews were transcribed and inductively coded to identify themes.
Five "barriers" themes emerged: (1) competing priorities, (2) patient challenges/resistance, (3) complex staffing/challenging cross-discipline coordination, (4) mixed perceptions about whether tobacco is a mental health care responsibility, and (5) limited staff training/comfort in treating tobacco. Five "facilitators" themes emerged: (1) reminding mental health staff about tobacco, (2) staff belief in the importance of addressing tobacco, (3) designating a cessation medication prescriber, (4) linking tobacco to mental health outcomes and norms, and (5) limiting mental health staff burden.
VA mental health staff struggle with knowing that tobacco use is important, but they face competing priorities, encounter patient resistance, are conflicted on their role in addressing tobacco, and lack tobacco training. They suggested strategies at multiple levels that would help overcome those barriers that can be used to design interventions that improve tobacco treatment delivery for mental health patients.
This study builds upon the existing literature on the high rates of smoking, but low rates of treatment, in people with mental health diagnoses. This study is one of the few qualitative evaluations of mental health clinic staff perceptions of barriers and facilitators to treating tobacco. The study results provide a multi-level framework for developing strategies to improve the implementation of tobacco treatment programs in mental health clinics.
患有心理健康障碍的退伍军人吸烟率很高，但接受烟草治疗的比例却很低。我们试图了解退伍军人事务部（VA）心理健康诊所治疗烟草使用的障碍和促进因素。
这项定性研究是评估一项电话护理协调计划的一部分，该计划针对在 VA 六家机构使用心理健康服务的吸烟者。我们对 14 名工作人员进行了半结构化访谈：12 名在参与研究的干预地点工作的心理健康诊所工作人员（6 名精神科医生、3 名心理学家、2 名社会工作者和 1 名家庭医生），以及一名在 VA 国家烟草咨询委员会工作的精神科医生和一名心理学家。访谈记录被转录并进行归纳编码，以确定主题。
出现了五个“障碍”主题：（1）优先事项相互竞争，（2）患者的挑战/抵制，（3）复杂的人员配置/跨学科协调困难，（4）对烟草是否属于精神健康护理责任的看法不一致，以及（5）治疗烟草方面的培训和舒适度有限。出现了五个“促进因素”主题：（1）提醒心理健康工作人员注意烟草问题，（2）工作人员对解决烟草问题的重要性的信念，（3）指定一名戒烟药物处方医生，（4）将烟草与精神健康结果和规范联系起来，以及（5）减轻心理健康工作人员的负担。
VA 心理健康工作人员深知吸烟的重要性，但他们面临着相互竞争的优先事项、患者的抵制、在解决烟草问题方面的角色冲突，以及缺乏烟草培训等问题。他们提出了一些可以帮助克服这些障碍的多层次策略，这些策略可以用来设计干预措施，改善精神健康患者的烟草治疗效果。
这项研究建立在现有的关于患有心理健康诊断的人群吸烟率高但治疗率低的文献基础上。这项研究是为数不多的对心理健康诊所工作人员对治疗烟草的障碍和促进因素的看法进行定性评估的研究之一。研究结果为制定在心理健康诊所中实施烟草治疗计划的策略提供了一个多层次的框架。
