Grable John C, Shan Kevin, Wang Matthew, Han Daniel D, Sportiello Kristen, Chang Melissa, Sysol Justin R, Bugbee Doris, Peltzer Kenneth
Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA.
J Multidiscip Healthc. 2024 Feb 7;17:601-607. doi: 10.2147/JMDH.S447462. eCollection 2024.
Providing effective tobacco dependence treatments to hospitalized patients remains a challenge. Prior to 2021, the Rochester Model program used staff nurses for both bedside and post-discharge counseling necessary to maintain abstinence. When nurse shortages and elevated job stress occurred during the COVID Pandemic, we proposed that medical students learn to counsel patients at the bedside and after discharge.
Due to COVID restrictions, first- and second-year medical students trained using remote Zoom sessions. The total training time was 2.5 hr without role-play or additional evaluations. A survey measured the students' satisfaction, confidence, and counseling barriers. A smoking patient on a participating hospital unit can enroll in the program. Students delivered bedside counseling, then provided follow-up treatment and outcome calls along with New York State Quitline counselors.
The survey demonstrated that 89% of the students were satisfied with the training. The bedside counseling confidence was greater than the phone counseling confidence. All students felt the program experience has value to them as future physicians. 124 smoking patients enrolled, and outcomes followed out to 6 months. The 7-day point prevalence quit rates using the as-treated (patients contacted) analysis were 57% at 4 weeks, 48% at 3 months, and 43% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis were 31% at 4 weeks, 16% at 3 months and 14% at 6 months.
Medical students given minimal training are effective tobacco cessation counselors at no cost to the hospital system. The Rochester Model program using student counseling benefits patients, the students, and the health-care system.
为住院患者提供有效的烟草依赖治疗仍然是一项挑战。在2021年之前，罗切斯特模式项目使用护士进行维持戒烟所需的床边和出院后咨询。在新冠疫情期间出现护士短缺和工作压力增加时，我们提议医学生学习在床边和出院后为患者提供咨询。
由于新冠疫情限制，一、二年级医学生通过远程Zoom课程进行培训。总培训时间为2.5小时，无角色扮演或额外评估。一项调查测量了学生的满意度、信心和咨询障碍。参与项目的医院科室的吸烟患者可报名参加该项目。学生进行床边咨询，然后与纽约州戒烟热线顾问一起提供后续治疗和结果随访电话。
调查显示89%的学生对培训满意。床边咨询的信心高于电话咨询的信心。所有学生都认为该项目经历对他们未来成为医生有价值。124名吸烟患者报名参加，随访结果至6个月。采用治疗分析（接触患者）时，4周时7天点患病率戒烟率为57%，3个月时为48%，6个月时为43%。采用意向性分析（所有患者）时，4周时7天点患病率戒烟率为31%，3个月时为16%，6个月时为14%。
接受最少培训的医学生可成为有效的戒烟顾问，且对医院系统无需成本。使用学生咨询的罗切斯特模式项目使患者、学生和医疗保健系统均受益。
