增加酒精和其他药物治疗中心戒烟护理服务的效果：一项集群随机对照试验。

Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial.

机构信息

Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.

Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.

出版信息

Addiction. 2020 Jul;115(7):1345-1355. doi: 10.1111/add.14911. Epub 2020 Jan 6.

DOI:10.1111/add.14911

PMID:31762105

Abstract

AIM

Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up.

DESIGN

Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016.

SETTING

Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician.

PARTICIPANTS

Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%).

INTERVENTION

Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care.

MEASUREMENTS

Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent.

FINDINGS

At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use.

CONCLUSIONS

Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.

摘要

目的

旨在测试将戒烟治疗纳入常规酒精和其他药物（AOD）治疗的组织变革干预措施的有效性，与常规护理相比，（1）8 周随访时的 7 天点患病率（PPA）；（2）延长禁欲；（3）每天吸烟的香烟数量；（4）戒烟尝试次数；（5）尼古丁替代疗法（NRT）的提供和使用。所有结果均在 8 周和 6.5 个月时进行评估。

设计

采用整群随机对照试验，以 AOD 服务为随机分组单位，于 2015 年 1 月至 2016 年 3 月进行。

设置

澳大利亚 32 家符合条件的服务机构（每年为≥50 名客户提供面对面的客户会议）通过独立的盲法生物统计学家随机分为对照组（常规护理；n=15）或干预组（n=17）。

参与者

符合条件的参与者（≥16 岁，当前吸烟者）在基线时在服务处完成了调查（n=896），并在 8 周（n=471；53%）和 6.5 个月（n=427；48%）时通过盲法评估人员进行了电话随访调查。

干预

干预服务部门接受了一项干预措施，以建立常规的筛查、评估和戒烟护理。

测量

主要结局是 8 周时生物验证的 7 天 PPA。次要结局包括验证和自我报告的延长禁欲、自我报告的 7 天 PPA、每日吸烟量、戒烟尝试和 NRT 的提供和使用。采用意向治疗分析，假设缺失参与者未禁欲。

结果

在 8 周时，两组间 7 天 PPA 的验证结果[2.6%对 1.8%，比值比（OR）=1.72，95%置信区间（CI）=0.5-5.7，P=0.373]不确定是否存在差异。与常规护理组相比，干预组在 8 周时报告的平均每日吸烟量明显较低[发生率比（IRR）=0.88，95%CI=0.8-0.95，P=0.001]，但在 6.5 个月时相似（IRR=0.96，95%CI=0.9-1.02，P=0.240）。在两个随访中，干预组报告的 NRT 使用比例均较高。