结合默认选择与就诊决策辅助工具以改善初级保健患者的戒烟情况：一项实用的整群随机试验

Combining Default Choices and an Encounter Decision Aid to Improve Tobacco Cessation in Primary Care Patients: A Pragmatic, Cluster-Randomized Trial.

作者信息

Selby Kevin, Habfast-Robertson Inès, Durand Marie-Anne, Hempel-Bruder Christina, Boesch Anne, Marti Joachim, Kazaal Yasser, Faouzi Mohamed, Maisonneuve Hubert, Berlin Ivan

机构信息

Department of Ambulatory Care, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1011, Lausanne, Switzerland.

The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.

出版信息

J Gen Intern Med. 2024 Oct 9. doi: 10.1007/s11606-024-09088-9.

DOI:10.1007/s11606-024-09088-9

PMID:39384691

Abstract

BACKGROUND

Primary care providers (PCPs) prescribe less often treatments for smoking cessation than for other major risk factors. We assessed the effect of training PCPs to offer smoking cessation treatments to current smokers as the default choice using an encounter decision aid (DA) on smoking cessation.

METHODS

Pragmatic, cluster-randomized controlled trial with PCPs in private practice in Switzerland and France. The intervention was a half-day course teaching PCPs the default choice approach using a DA. Control PCPs received a 1-h refresher training on smoking cessation aids. PCPs recruited daily smokers seen for routine care. The primary outcome was self-reported, 7-day, point prevalence smoking abstinence at 6 months. Secondary outcomes were quit attempts and use of smoking cessation aids at 3 weeks, 3 months, and 6 months, and a patient-reported measure of shared decision-making (CollaboRATE scale 1-10, higher scores = more involvement).

RESULTS

Forty-two PCPs completed the training (76% Swiss) and recruited 287 current smokers (105 intervention group, 182 control group), with 51% women, mean age 48 (SD, 2.6), 77% who smoked <20 cigarettes/day, and 221 who responded at 6 months follow-up (77%). The intervention did not affect self-reported smoking abstinence rate at 6 months (9.5% intervention and 10.4% control groups, respectively; OR 0.88 (95%CI 0.37-2.10). It did however increase the number of quit attempts at 3 weeks (OR 2.09, 95%CI 1.04-4.20) and the use of smoking cessation aids at the 3-week and 3-month follow-ups (OR 2.57, 95%CI 1.21-5.45 and OR 2.00, 95%CI 1.11-3.60, respectively). The mean CollaboRATE score was 8.05/10 in the intervention group and 7.28/10 in the control group (p=0.02), reflecting more patient involvement in decision-making.

CONCLUSION

Training PCPs to use a decision aid did not improve smoking abstinence rate, despite short-term increases in quit attempts and use of smoking cessation aids. It improved patient involvement in decision-making.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04868474.

摘要

背景

与其他主要风险因素相比，初级保健提供者（PCP）开具戒烟治疗的频率较低。我们评估了培训初级保健提供者将为当前吸烟者提供戒烟治疗作为默认选择，并使用戒烟的诊疗决策辅助工具（DA）的效果。

方法

在瑞士和法国私人执业的初级保健提供者中进行务实的整群随机对照试验。干预措施是为期半天的课程，教初级保健提供者使用诊疗决策辅助工具的默认选择方法。对照初级保健提供者接受了为期1小时的戒烟辅助工具复习培训。初级保健提供者招募前来接受常规护理的每日吸烟者。主要结局是6个月时自我报告的7天点患病率戒烟情况。次要结局包括3周、3个月和6个月时的戒烟尝试及戒烟辅助工具的使用情况，以及患者报告的共同决策测量指标（协作评分量表1 - 10分，分数越高 = 参与度越高）。

结果

42名初级保健提供者完成了培训（76%来自瑞士），招募了287名当前吸烟者（105名干预组，182名对照组），其中51%为女性，平均年龄48岁（标准差2.6），77%每天吸烟少于20支，221人在6个月随访时做出回应（77%）。干预措施并未影响6个月时自我报告的戒烟率（干预组和对照组分别为9.5%和10.4%；比值比0.88（95%置信区间0.37 - 2.10）。然而，它确实增加了3周时的戒烟尝试次数（比值比2.09，95%置信区间1.04 - 4.20）以及3周和3个月随访时戒烟辅助工具的使用情况（分别为比值比2.57，95%置信区间1.21 - 5.45和比值比2.00，95%置信区间1.11 - 3.60）。干预组的平均协作评分是8.05/10，对照组是7.28/10（p = 0.02），这反映出患者在决策过程中的参与度更高。