Thorndike A N, Rigotti N A, Stafford R S, Singer D E
Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston 02114, USA.
JAMA. 1998 Feb 25;279(8):604-8. doi: 10.1001/jama.279.8.604.
Routine treatment of smokers by physicians is a national health objective for the year 2000, a quality measure for health care plans, and the subject of evidence-based clinical guidelines. There are few national data on how physicians' practices compare with these standards.
To assess recent trends in the treatment of smokers by US physicians in ambulatory care and to determine whether physicians' practices meet current standards.
Analysis of 1991-1995 data from the National Ambulatory Medical Care Survey, an annual survey of a random sample of US office-based physicians.
Physicians' offices.
A total of 3254 physicians recorded data on 145716 adult patient visits.
The proportion of visits at which physicians (1) identified a patient's smoking status, (2) counseled a smoker to quit, and (3) used nicotine replacement therapy.
Smoking counseling by physicians increased from 16% of smokers' visits in 1991 to 29% in 1993 (P<.001) and then decreased to 21% of smokers' visits in 1995 (P<.001). Nicotine replacement therapy use followed a similar pattern, increasing from 0.4% of smokers' visits in 1991 to 2.2% in 1993 (P<.001) and decreasing to 1.3% of smokers' visits in 1995 (P=.007). Physicians identified patients' smoking status at 67% of all visits in 1991; this proportion did not increase over time. Primary care physicians were more likely to provide treatment to smokers than were specialists. All physicians were more likely to treat patients with smoking-related diagnoses.
US physicians' treatment of smokers improved little in the first half of the 1990s, although a transient peak in counseling and nicotine replacement use occurred in 1993 after the introduction of the nicotine patch. Physicians' practices fell far short of national health objectives and practice guidelines. In particular, patient visits for diagnoses not related to smoking represent important missed opportunities for intervention.
医生对吸烟者进行常规治疗是2000年的一项国家卫生目标，是医疗保健计划的一项质量指标，也是循证临床指南的主题。关于医生的治疗行为与这些标准相比情况如何，全国性数据很少。
评估美国医生在门诊治疗吸烟者的近期趋势，并确定医生的治疗行为是否符合当前标准。
对1991 - 1995年全国门诊医疗调查数据进行分析，该调查每年对美国门诊医生的随机样本进行。
医生办公室。
共有3254名医生记录了145716例成年患者就诊的数据。
医生在就诊时（1）确定患者吸烟状况、（2）劝告吸烟者戒烟、（3）使用尼古丁替代疗法的比例。
医生对吸烟者的劝告从1991年吸烟者就诊的16%增加到1993年的29%（P<0.001），然后在1995年降至吸烟者就诊的21%（P<0.001）。尼古丁替代疗法的使用也遵循类似模式，从1991年吸烟者就诊的0.4%增加到1993年的2.2%（P<0.001），在1995年降至吸烟者就诊的1.3%（P = 0.007）。1991年医生在67%的就诊中确定了患者的吸烟状况；这一比例未随时间增加。初级保健医生比专科医生更有可能为吸烟者提供治疗。所有医生对有吸烟相关诊断的患者更有可能进行治疗。
在20世纪90年代上半叶，美国医生对吸烟者的治疗改善不大，尽管在尼古丁贴片推出后的1993年，劝告和尼古丁替代疗法的使用出现了短暂高峰。医生的治疗行为远远未达到国家卫生目标和实践指南。特别是，与吸烟无关的诊断患者就诊代表了重要的干预错失机会。
