孕期戒烟护理的哪些组成部分由卫生保健提供者实施？系统评价和荟萃分析。
What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis.
机构信息
School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
出版信息
BMJ Open. 2019 Aug 18;9(8):e026037. doi: 10.1136/bmjopen-2018-026037.
BACKGROUND
Pregnancy is an opportunity for health providers to support women to stop smoking.
OBJECTIVES
Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.
DESIGN
A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', 'Advise', 'Assess', 'Assist', 'Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.
DATA SOURCES
MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using 'smoking', 'pregnancy' and 'health provider practices'.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017.
PARTICIPANTS
Health providers of any profession.
DATA EXTRACTION, APPRAISAL AND ANALYSIS: Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, 'often/always' and 'always/all'. Meta-regressions were performed of 5As for 'often/always'.
RESULTS
Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices 'often/always' were: 'Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), 'Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), 'Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), 'Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and 'prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I) was 95.9%-99.1%. Meta-regressions for 'Arrange' were significant for year (p=0.013) and country (p=0.037).
CONCLUSIONS
Health providers 'Ask', 'Advise' and 'Assess' most pregnant women about smoking. 'Assist', 'Arrange' and 'prescribing NRT' are reported at lower rates: strategies to improve these should be considered.
PROSPERO REGISTRATION NUMBER
CRD42015029989.
背景
怀孕为医疗保健提供者提供了支持女性戒烟的机会。
目的
确定向怀孕期间吸烟的女性提供戒烟护理的卫生保健提供者提供各组成部分的综合流行率。
设计
系统综述综合了报告卫生保健提供者实施 5A （询问、建议、评估、协助、安排）、开具尼古丁替代疗法（NRT）和（2）与戒烟护理相关的因素的原始文章。
数据来源
使用“吸烟”、“怀孕”和“卫生保健提供者实践”在 MEDLINE、EMBASE、CINAHL 和 PsycINFO 数据库中搜索。
纳入研究的标准
除干预措施（自我报告、审核、观察咨询和妇女报告）外，研究设计包括任何设计，均为英文，无日期限制，截至 2017 年 6 月。
参与者
任何专业的卫生保健提供者。
数据提取、评估和分析：使用 Hawker 工具提取数据，然后进行评估。使用例如“经常/总是”和“总是/全部”，对每个 5A 和开具 NRT 的百分比进行荟萃分析。对 5A 的“经常/总是”进行了元回归。
结果
在 3933 篇论文中，有 54 篇被纳入（n=29225 名参与者）：33 篇进行荟萃分析。卫生保健提供者包括来自 10 个国家的全科医生、产科医生、助产士和其他人员。报告实践“经常/总是”的研究的汇总百分比为：“询问”（n=9）91.6%（95%CI 88.2%至 95%）；“建议”（n=7）90%（95%CI 72.5%至 99.3%），“评估”（n=3）79.2%（95%CI 76.5%至 81.8%），“协助（戒烟支持）”（n=5）59.1%（95%CI 56%至 62.2%），“安排（转介）”（n=6）33.3%（95%CI 20.4%至 46.2%）和“开具 NRT”（n=6）25.4%（95%CI 12.8%至 38%）。异质性（I）为 95.9%-99.1%。“安排”的元回归对年份（p=0.013）和国家（p=0.037）具有统计学意义。
结论
卫生保健提供者最常向大多数孕妇询问关于吸烟的问题。报告的“协助”、“安排”和“开具 NRT”的比例较低：应考虑采取策略来提高这些比例。
PROSPERO 注册号：CRD42015029989。
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