患者对风湿科戒烟和干预措施的看法。
Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.
机构信息
University of Wisconsin, Madison.
Medical College of Wisconsin, Milwaukee, and University of Iowa, Iowa City.
出版信息
Arthritis Care Res (Hoboken). 2020 Mar;72(3):369-377. doi: 10.1002/acr.23858.
OBJECTIVE
Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. After implementing a rheumatology clinic protocol that increased tobacco quitline referrals 20-fold, we undertook this study to examine patients' barriers and facilitators to smoking cessation based on prior rheumatology experiences, to solicit reactions to the new cessation protocol, and to identify patient-centered outcomes or signs of cessation progress following improved care.
METHODS
We recruited 19 patients who smoke (12 with rheumatoid arthritis [RA] and 7 with systemic lupus erythematosus [SLE]) to participate in 1 of 3 semistructured focus groups. Transcripts of the focus group discussions were analyzed using thematic analysis to classify barriers, facilitators, and signs of cessation progress.
RESULTS
Participant-reported barriers and facilitators to cessation involved psychological, health-related, and social and economic factors, as well as health care messaging and resources. Commonly discussed barriers included viewing smoking as a crutch amid rheumatic disease, rarely receiving cessation counseling in rheumatology clinics, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatic disease medications. Participants endorsed our cessation protocol with rheumatology-specific education and accessible resources, such as a quitline. Beyond quitting, participants prioritized knowing why and how to quit as signs of progress outcomes.
CONCLUSION
Focus groups identified themes and categories of facilitators/barriers to smoking cessation at the levels of patient and health system. Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources is essential when designing and evaluating rheumatology smoking cessation interventions.
目的
尽管吸烟是心血管疾病和风湿性疾病严重程度的一个危险因素，但只有 10%的风湿科就诊记录有戒烟咨询。在实施了一项使戒烟热线转介增加 20 倍的风湿科诊所方案后，我们开展了这项研究，以根据患者之前的风湿科就诊经历，了解他们戒烟的障碍和促进因素，征求他们对新戒烟方案的反应，并确定在改善治疗后与患者为中心的戒烟结果或进展迹象。
方法
我们招募了 19 名吸烟的患者（12 名类风湿关节炎 [RA] 和 7 名系统性红斑狼疮 [SLE]），参加了 3 个半结构化焦点小组中的 1 个。使用主题分析对焦点小组讨论的记录进行分析，以对障碍、促进因素和戒烟进展迹象进行分类。
结果
参与者报告的戒烟障碍和促进因素涉及心理、健康相关以及社会和经济因素，以及医疗保健信息传递和资源。讨论中常见的障碍包括将吸烟视为风湿性疾病中的拐杖、很少在风湿科诊所接受戒烟咨询，以及对吸烟会使风湿性疾病恶化或降低某些风湿性疾病药物疗效的认识非常有限。参与者认可了我们的具有风湿科特定教育和便捷资源（如戒烟热线）的戒烟方案。除了戒烟外，参与者还将了解为什么以及如何戒烟作为进展结果的标志。
结论
焦点小组确定了患者和卫生系统层面上戒烟的促进因素/障碍的主题和类别。改善 RA 和 SLE 患者戒烟护理的两个关键结果是了解为什么以及如何戒烟。在设计和评估风湿科戒烟干预措施时，强调风湿学健康益处和戒烟资源至关重要。
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