The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, Callaghan, NSW, Australia.
Hunter New England Population Health, Wallsend, NSW, Australia.
Addiction. 2018 Dec;113(12):2158-2172. doi: 10.1111/add.14369. Epub 2018 Jul 27.
Organizational change interventions involve systems and cultural change within health-care services to make smoking cessation care delivery part of usual treatment. Six strategies for organizational change have been proposed. This study examined the evidence for organizational change interventions in the alcohol and other drug (AOD) setting on: (a) smoking cessation care; and (b) smoking cessation and cessation-related outcomes.
A systematic review with narrative synthesis was conducted. MEDLINE, PsycINFO, CINAHL, EMBASE and Scopus were searched using keywords and MeSH terms from database inception to 1 June 2018. Interventions were assessed against the six organizational change strategies.
Of the 5155 papers identified, 14 publications from seven unique studies were included. Most studies employed four or fewer organizational change strategies. The majority (n = 11) were rated weak to moderate in methodological quality. Nine published papers, four unique studies, examined staff reported provision of smoking cessation care; eight reported an increase, one found no change. Three papers, two unique studies, examined client receipt of care; all found significant increases. Three papers, two unique studies, assessed staff smoking prevalence from pre- to post-intervention. Only one study reported a significant reduction in staff smoking prevalence (35.2 versus 21.8%, P = 0.005). Nine papers, six unique studies, assessed client smoking cessation and smoking-related outcomes. Seven papers reported on client smoking prevalence; two found a significant decrease and five found no change to smoking. Four papers reported on number of cigarettes per day, three found a significant decrease and one found no change. Two papers reported on smoking cessation finding a 10% and a 25% seven-day point prevalence abstinence post-discharge from the AOD service.
Organizational change interventions within health-care services to make smoking cessation care delivery part of usual treatment offer promise for increasing smoking cessation care and reducing smoking prevalence.
组织变革干预措施涉及医疗服务系统和文化变革，以使戒烟护理成为常规治疗的一部分。已经提出了六种组织变革策略。本研究考察了在酒精和其他药物（AOD）环境中针对以下方面的组织变革干预措施的证据：（a）戒烟护理；（b）戒烟和与戒烟相关的结果。
进行了系统评价和叙述性综合分析。使用关键词和 MeSH 术语从数据库开始到 2018 年 6 月 1 日在 MEDLINE、PsycINFO、CINAHL、EMBASE 和 Scopus 中进行了搜索。干预措施根据六个组织变革策略进行了评估。
在确定的 5155 篇论文中，有 14 篇出版物来自 7 项独特的研究。大多数研究采用了四个或更少的组织变革策略。大多数（n=11）的方法学质量为弱到中等。9 篇已发表的论文，4 项独特的研究，检查了工作人员报告的戒烟护理提供情况；8 项报告增加，1 项发现没有变化。3 篇论文，2 项独特的研究，评估了客户接受护理的情况；所有研究均发现显著增加。3 篇论文，2 项独特的研究，评估了员工吸烟率从干预前到干预后的变化。只有一项研究报告称员工吸烟率显著降低（35.2 与 21.8%，P=0.005）。9 篇论文，6 项独特的研究，评估了客户的戒烟和与吸烟相关的结果。7 篇论文报告了客户吸烟率；2 项研究发现吸烟率显著下降，5 项研究发现吸烟率没有变化。4 篇论文报告了每天吸烟的数量，3 项研究发现吸烟量显著减少，1 项研究发现没有变化。2 篇论文报告了吸烟的发现，在从 AOD 服务出院后七天的时间内，有 10%和 25%的患者有七天的戒烟率。
在医疗服务中进行组织变革干预措施，以使戒烟护理成为常规治疗的一部分，有望增加戒烟护理，并降低吸烟率。
