Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
Centre for Tobacco and Alcohol Studies, Nottingham, UK.
BMC Public Health. 2020 Apr 25;20(1):559. doi: 10.1186/s12889-020-08672-y.
Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient's smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)).
We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012-September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free policy; C) enhancements to the patient electronic healthcare record (EHCR) which included C1) a temporary form to record the financial incentivisation of ASK and ACT (OFFER) C2) amendments to how VBA was recorded in the EHCR and C3) the integration of a new electronic national referral system in the EHCR. The recording of ASK, ADVISE, ACT (OFFER/CONSENT) were extracted using a de-identified psychiatric case register.
There were 8976 admissions of 5434 unique individuals during the study period. Following A) financial incentive, the odds of recording ASK increased (OR: 1.56, 95%CI: 1.24-1.95). Following B) comprehensive smoke-free policy, the odds of recording ADVICE increased (OR: 3.36, 95%CI: 1.39-8.13). Following C1) temporary recording form, the odds of recording ASK (OR:1.99, 95%CI:1.59-2.48) and recording ACT (OFFER) increased (OR: 4.22, 95%CI: 2.51-7.12). Following C3) electronic referral system, the odds of recording ASK (OR:1.79, 95%CI: 1.31-2.43) and ACT (OFFER; OR: 1.09, 95%CI: 0.59-1.99) increased. There was no change in recording VBA outcomes following C2) amendments to VBA recording.
Financial incentives and the recording of incentivised outcomes, the comprehensive smoke-free policy, and the electronic referral system, were associated with increases in recording individual VBA elements, but other changes to the EHCR were not. System-level changes may facilitate staff recording of VBA provision in mental health settings.
精神疾病患者的吸烟率仍然很高。提供非常简短的建议（VBA），包括：i）询问，确定患者的吸烟状况；ii）建议，提供最佳的戒烟方法；iii）行动（提供），提供专业戒烟支持的转诊，增加一般人群的戒烟尝试。我们评估了英国一家精神卫生机构的系统层面的变化是否提高了记录提供 ASK、ADVISE、ACT（提供）和同意转诊至专业戒烟支持（ACT（同意））的情况。
我们在四家精神病院进行了一项使用回归不连续性设计的研究，这些医院的患者在 52 个月（2012 年 5 月至 2016 年 9 月）内接受了住院精神病服务的治疗。为促进 VBA 的提供而进行的系统层面的变化包括：A）对记录吸烟状况和提供支持（ASK 和 ACT（提供））进行财务激励；B）实施全面禁烟政策；C）增强患者电子医疗记录（EHR），包括 C1）临时表格，用于记录 ASK 和 ACT（提供）的财务激励，C2）在 EHR 中记录 VBA 的修订，以及 C3）在 EHR 中整合新的国家电子转诊系统。使用去识别的精神病病例登记册提取 ASK、ADVISE、ACT（提供/同意）的记录。
在研究期间，共有 8976 次住院治疗，涉及 5434 名独特的患者。在 A）财务激励之后，记录 ASK 的几率增加（OR：1.56，95%CI：1.24-1.95）。在 B）全面禁烟政策之后，记录 ADVICE 的几率增加（OR：3.36，95%CI：1.39-8.13）。在 C1）临时记录表格之后，记录 ASK（OR：1.99，95%CI：1.59-2.48）和记录 ACT（提供）（OR：4.22，95%CI：2.51-7.12）的几率增加。在 C3）电子转诊系统之后，记录 ASK（OR：1.79，95%CI：1.31-2.43）和 ACT（提供；OR：1.09，95%CI：0.59-1.99）的几率增加。在 C2）修订 VBA 记录后，VBA 结果的记录没有变化。
财务激励和记录激励性结果、全面禁烟政策和电子转诊系统与记录个别 VBA 要素的增加有关，但电子健康记录的其他变化则不然。系统层面的变化可能有助于精神卫生机构的工作人员记录 VBA 的提供情况。
