Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
Am J Prev Med. 2020 Jul;59(1):88-97. doi: 10.1016/j.amepre.2020.01.031. Epub 2020 May 14.
Recent guideline changes for lung cancer screening with low-dose computed tomography recommend smoking-cessation interventions be done in parallel with screening. The purpose of this study is to determine the post-guideline rates of smoking-cessation interventions among patients eligible and ineligible for lung cancer screening.
Using electronic health records collected from a large ambulatory care system in northern California between 2010 and 2017, authors identified new patients who were current smokers aged 55-80 years visiting a primary care provider, and grouped patients into lung cancer screening-eligible heavy smokers, screening-ineligible moderate smokers, and screening-ineligible light smokers. Screening-eligible smokers versus screening-ineligible smokers were compared in receipt of smoking-cessation interventions before (2010-2013) and after (2014-2017) the guideline change, overall and by intervention type (formal counseling, informal counseling, pharmacotherapy) using hierarchical generalized linear models. Analyses were conducted in 2018-2019.
After the guideline change, the likelihood of receiving any smoking-cessation intervention (OR=1.44, 95% CI=1.28, 1.61, p<0.05), informal counseling (OR=1.29, 95% CI=1.15, 1.46, p<0.05), and pharmacotherapy (OR=1.24, 95% CI=1.02, 1.50, p<0.05) during a new patient visit significantly increased, with the increase not varying by level of smoking. For formal counseling, the post-guideline increase was greater for screening-eligible heavy smokers (OR=3.15, 95% CI=1.18, 8.36, p<0.05) and moderate smokers (OR=3.58, 95% CI=1.29, 9.95, p<0.05) relative to light smokers.
Smoking-cessation interventions increased after new lung cancer screening guidelines. Given the sizable adverse impacts of smoking on morbidity and mortality, small increases in the implementation of smoking-cessation interventions could have substantial public health benefits.
最近，针对肺癌低剂量计算机断层扫描筛查的指南更新建议，在进行筛查的同时，也要进行戒烟干预。本研究的目的是确定符合和不符合肺癌筛查条件的患者接受戒烟干预的比例。
作者使用了 2010 年至 2017 年间，从加利福尼亚州北部一个大型门诊医疗系统中收集的电子健康记录，确定了前来就诊的年龄在 55-80 岁之间的当前吸烟者新患者，并将患者分为肺癌筛查合格的重度吸烟者、筛查不合格的中度吸烟者和筛查不合格的轻度吸烟者。使用分层广义线性模型，比较了指南变更前后（2010-2013 年和 2014-2017 年），筛查合格的吸烟者和筛查不合格的吸烟者是否接受了戒烟干预（包括正式咨询、非正式咨询和药物治疗），并按干预类型进行了分层。分析于 2018-2019 年进行。
指南更新后，接受任何戒烟干预（比值比=1.44，95%置信区间=1.28，1.61，p<0.05）、非正式咨询（比值比=1.29，95%置信区间=1.15，1.46，p<0.05）和药物治疗（比值比=1.24，95%置信区间=1.02，1.50，p<0.05）的可能性在新患者就诊时显著增加，且这种增加与吸烟程度无关。对于正式咨询，在符合筛查条件的重度吸烟者（比值比=3.15，95%置信区间=1.18，8.36，p<0.05）和中度吸烟者（比值比=3.58，95%置信区间=1.29，9.95，p<0.05）中，这种增加幅度大于轻度吸烟者。
新的肺癌筛查指南发布后，戒烟干预有所增加。鉴于吸烟对发病率和死亡率的巨大不利影响，戒烟干预的实施略有增加，可能会产生巨大的公共卫生效益。
