Bailey Steffani R, Stevens Victor J, Fortmann Stephen P, Kurtz Stephen E, McBurnie Mary Ann, Priest Elisa, Puro Jon, Solberg Leif I, Schweitzer Rebecca, Masica Andrew L, Hazlehurst Brian
1 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
2 Kaiser Permanente Center for Health Research, Portland, OR, USA.
Am J Health Promot. 2018 Sep;32(7):1582-1590. doi: 10.1177/0890117118761886. Epub 2018 Mar 13.
To test the association between repeated clinical smoking cessation support and long-term cessation.
Retrospective, observational cohort study using structured and free-text data from electronic health records.
Six diverse health systems in the United States.
Patients aged ≥18 years who were smokers in 2007 and had ≥1 primary care visit in each of the following 4 years (N = 33 691).
Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, and ≥75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for ≥365 days following a visit where nonsmoker or former smoker was indicated.
Mixed effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation.
Overall, 20% of the cohort achieved LTQ status. Patients with ≥75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types.
These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.
检验重复的临床戒烟支持与长期戒烟之间的关联。
采用电子健康记录中的结构化和自由文本数据进行回顾性观察队列研究。
美国六个不同的医疗系统。
2007年为吸烟者且在随后4年中每年至少有1次初级保健就诊的18岁及以上患者（N = 33691）。
主要暴露因素是一个复合分类变量（由戒烟药物、咨询或转诊的记录组成），用于对患者接受任何戒烟援助的就诊比例进行分类（<25%（参考）、25%-49%、50%-74%和≥75%的就诊）。因变量是长期戒烟（LTQ；是/否），定义为在显示为非吸烟者或既往吸烟者的就诊后≥365天无当前吸烟者的迹象。
采用混合效应逻辑回归分析，对年龄、性别、种族和合并症进行调整，并采用稳健标准误估计以考虑站点内的相关性。
总体而言，20%的队列达到了长期戒烟状态。与接受援助就诊比例<25%的患者相比，接受任何援助就诊比例≥75%的患者实现长期戒烟状态的几率几乎高出3倍（优势比 = 2.84；95%置信区间：1.50-5.37）。特定援助类型的结果相似。
这些发现支持了在初级保健就诊时重复提供援助以增加长期戒烟的重要性。
