美国各专科医生对烟草治疗指南的使用及影响因素
Tobacco Treatment Guideline Use and Predictors Among U.S. Physicians by Specialty.
机构信息
The Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey.
出版信息
Am J Prev Med. 2021 Dec;61(6):882-889. doi: 10.1016/j.amepre.2021.05.014. Epub 2021 Aug 5.
INTRODUCTION
Physicians play a critical role in tobacco treatment, being a frequent link to smokers and a trusted source of information. Unfortunately, barriers exist that limit physicians' implementation of evidence-based interventions. This study examines the implementation and predictors of the Ask, Advise, Assess, Assist, Arrange model of tobacco treatment clinical guidelines among U.S. physicians.
METHODS
A national sample of 1,058 U.S. physicians from 6 specialties (family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonology, and oncology) were surveyed in 2018 (51.8% response rate). Survey domains included demographics, awareness of the guidelines, tobacco treatment practices (i.e., Ask, Advise, Assess, Assist, Arrange model), perceived barriers to treatment, and perceived efficacy of various treatments. Multiple logistic regression analyzed the predictors of implementing guideline activities.
RESULTS
Mean age was 51.3 years, with the majority male (64.4%) and non-Hispanic White (63.9%). Nearly all physicians reported asking patients whether they smoke (95.6%) and advising them to stop (94.8%), slightly fewer assessed the readiness to quit (86.5%), and only a minority assisted with a quit plan (27.4%) or arranged a follow-up (18.6%). Only 18% reported using the U.S. Public Health Service Guidelines in clinical practice. Time-related factors were the most common barriers (53.4%), with patient factors (36.9%) and financial/resource factors (35.1%) cited less frequently. The predictors of implementing aspects of the Ask, Advise, Assess, Assist, Arrange model included physician awareness and utilization of the U.S. Public Health Service Guidelines, specialty, and to a smaller degree, graduating before 1990, not reporting time as a barrier, patient barriers, sex, and higher perceived effectiveness of pharmacotherapy.
CONCLUSIONS
This national survey highlights the need for increased implementation of all aspects of the latest guidelines for evidence-based tobacco treatments, including community-based resources.
简介
医生在烟草治疗中起着至关重要的作用，他们是吸烟者的常见联系人，也是可靠的信息来源。然而，存在一些限制医生实施循证干预的障碍。本研究在美国医生中调查了烟草治疗临床指南的“Ask、Advise、Assess、Assist、Arrange”模型的实施情况和预测因素。
方法
2018 年，对来自 6 个专业（家庭医学、内科、妇产科、心脏病学、肺病学和肿瘤学）的 1058 名美国医生进行了全国性调查（51.8%的回应率）。调查领域包括人口统计学、对指南的认识、烟草治疗实践（即“Ask、Advise、Assess、Assist、Arrange”模型）、治疗障碍的感知以及各种治疗方法的有效性感知。多变量逻辑回归分析了实施指南活动的预测因素。
结果
平均年龄为 51.3 岁，大多数为男性（64.4%）和非西班牙裔白人（63.9%）。几乎所有医生都报告询问患者是否吸烟（95.6%）并建议他们戒烟（94.8%），略少的医生评估了戒烟的准备情况（86.5%），只有少数医生协助制定戒烟计划（27.4%）或安排随访（18.6%）。只有 18%的医生报告在临床实践中使用美国公共卫生服务指南。时间相关因素是最常见的障碍（53.4%），患者因素（36.9%）和财务/资源因素（35.1%）较少被提及。实施“Ask、Advise、Assess、Assist、Arrange”模型各个方面的预测因素包括医生对美国公共卫生服务指南的认识和使用、专业以及在较小程度上，毕业于 1990 年前、不报告时间为障碍、患者障碍、性别以及更高的药物治疗效果感知。
结论
这项全国性调查强调了需要更广泛地实施最新循证烟草治疗指南的所有方面，包括社区资源。
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