Fiore M C, Jorenby D E, Schensky A E, Smith S S, Bauer R R, Baker T B
Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison 53706-1532.
Mayo Clin Proc. 1995 Mar;70(3):209-13. doi: 10.4065/70.3.209.
To assess the effect of expanding the vital signs to include smoking status.
We prospectively conducted exit interviews with patients at a general internal medicine clinic in Madison, Wisconsin, during a 16-month period from 1991 to 1993.
Patients were surveyed briefly before (N = 870) and after (N = 994) the implementation of a simple institutional change in clinical practice. This change involved training the staff in how to use progress notepaper with a vital sign stamp that included smoking status (current, former, or never) along with the traditional vital signs. Included in the survey were questions about whether the patient smoked, whether the patient was asked that day about smoking status (by a clinician or other staff), and, for smokers, whether they were urged to quit smoking and given specific advice on how to do so.
After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit (an increase from approximately 58% at baseline to 81% at intervention; P < 0.0001). The vital sign intervention was associated with significant increases in the percentage of smokers who reported that their clinician advised them that day to quit smoking (from approximately 49% at baseline to 70% during the intervention; P < 0.01) and in the percentage who reported that their clinician gave them specific advice that day on how to stop smoking (from approximately 24% at baseline to 43% during the intervention; P < 0.01).
Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist with smoking cessation. This simple, low-cost intervention may effectively prompt clinicians to inquire about use of tobacco and offer recommendations to smokers.
评估将生命体征扩展至包括吸烟状况的效果。
1991年至1993年的16个月期间，我们在威斯康星州麦迪逊市的一家普通内科诊所对患者进行了前瞻性出院访谈。
在临床实践中实施一项简单的制度变革之前（N = 870）和之后（N = 994），对患者进行简短调查。这一变革包括培训工作人员如何使用带有生命体征印章的病程记录纸，该印章除了传统生命体征外，还包括吸烟状况（目前吸烟、既往吸烟或从不吸烟）。调查问题包括患者是否吸烟、当天是否有人（临床医生或其他工作人员）询问其吸烟状况，对于吸烟者，是否有人敦促他们戒烟并给予具体的戒烟建议。
扩展生命体征后，患者更有可能报告在门诊就诊当天被询问吸烟状况（从基线时的约58%增至干预时的81%；P < 0.0001）。生命体征干预使报告临床医生当天建议其戒烟的吸烟者比例显著增加（从基线时的约49%增至干预期间的70%；P < 0.01），以及报告临床医生当天给予其具体戒烟建议的吸烟者比例显著增加（从基线时的约24%增至干预期间的43%；P < 0.01）。
将生命体征扩展至包括吸烟状况与识别吸烟患者以及干预鼓励和协助戒烟的比例大幅增加相关。这种简单、低成本的干预措施可能有效促使临床医生询问烟草使用情况并向吸烟者提供建议。
