From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac).
Can J Surg. 2021 Feb 3;64(1):E51-E58. doi: 10.1503/cjs.009919.
Smoking cessation programs started as late as 4 weeks before surgery reduce perioperative morbidity and death, yet outpatient clinic interventions are rarely provided. Our aim was to evaluate the feasibility of implementing a tobacco treatment protocol designed for an outpatient surgical setting.
We completed a pre-post feasibility study of the implementation of a systematic, evidence-based tobacco treatment protocol in an outpatient colorectal surgery clinic. Outcomes included smoking prevalence, pre- and postimplementation smoker identification and intervention rates, recruitment, retention, smoking cessation and provider satisfaction.
Preimplementation, 15.5% of 116 surveyed patients were smokers. Fewer than 10% of surveyed patients reported being asked about smoking, and none were offered any cessation intervention. Over a 16-month postimplementation period, 1198 patients were seen on 2103 visits. Of these, 950 (79.3%) patients were asked smoking status on first visit and 1030 (86.0%) were asked on at least 1 visit. Of 169 identified smokers, 99 (58.6%) were referred to follow-up support using an opt-out approach. At 1-, 3- and 6-month follow-up, intention-to-quit rates among 78 enrolled patients were 24.4%, 22.9% and 19.2%, respectively. Postimplementation staff surveys reported that the protocol was easy to use, that staff would use it again and that it had positive patient responses.
Implementation of our smoking cessation protocol in an outpatient surgical clinic was found to be feasible and used minimal clinic resources. This protocol could lead to increases in identification and documentation of smoking status, delivery of smoking cessation interventions and rates of smoking reduction and cessation.
在手术前 4 周开始戒烟计划可降低围手术期发病率和死亡率，但很少在门诊诊所提供干预措施。我们的目的是评估在门诊外科环境中实施针对吸烟治疗的方案的可行性。
我们对在门诊结肠直肠外科诊所实施系统的基于证据的吸烟治疗方案进行了前后可行性研究。结果包括吸烟流行率、实施前后吸烟者的识别和干预率、招募、保留、戒烟和提供者满意度。
在实施前，116 名接受调查的患者中有 15.5%是吸烟者。不到 10%的接受调查的患者报告被问及吸烟问题，也没有人提供任何戒烟干预措施。在实施后的 16 个月期间，有 1198 名患者在 2103 次就诊中接受了治疗。在这些患者中，950 名（79.3%）患者在首次就诊时被问及吸烟状况，1030 名（86.0%）患者在至少一次就诊时被问及吸烟状况。在 169 名确定的吸烟者中，99 名（58.6%）通过选择退出的方法被转介到后续支持中。在 1、3 和 6 个月的随访中，78 名入组患者的戒烟意向率分别为 24.4%、22.9%和 19.2%。实施后的员工调查报告称，该方案易于使用，员工将再次使用，并得到了患者的积极反馈。
在门诊外科诊所实施我们的戒烟方案是可行的，只需要很少的诊所资源。该方案可以提高对吸烟状况的识别和记录、提供戒烟干预措施以及减少和戒烟的比例。
