Ockene J K, Lindsay E A, Hymowitz N, Giffen C, Purcell T, Pomrehn P, Pechacek T
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Tob Control. 1997;6 Suppl 2(Suppl 2):S49-56. doi: 10.1136/tc.6.suppl_2.s49.
To compare tobacco control practices of physicians and their staff in Intervention communities with those in Comparison communities of the Community Intervention Trial for Smoking Cessation (COMMIT).
COMMIT was a randomised trial testing community-based intervention for smoking cessation carried out over four years.
Eleven matched pairs of communities assigned randomly to Intervention and Comparison conditions.
Physicians in the Intervention communities participated in continuing medical education (CME). Training for office staff focused on tobacco control and office intervention "systems".
Smoking control attitudes and practices reported by primary-care physicians in the 22 communities, smoking policies, and practices of 30 randomly selected medical offices in each community, and patient reports of physician intervention activities.
Response rates to the physicians' mail survey were 45% and 42% in Intervention and Comparison communities, respectively. Telephone interviews of office staff had response rates of 84% in both conditions. Physicians in Intervention communities were more likely to attend training than those in Comparison communities (53% and 26%, respectively (P<0.0005)). In both conditions, training attendees perceived themselves as being better prepared to counsel smokers than non-attendees (P < or = 0.01) and reported more activity in smoking intervention. Intervention communities carried out more office-based tobacco control activities (P = 0.002). Smokers in Intervention communities were more likely to report receiving reading material about smoking from their physicians (P = 0.026). No other differences in physician intervention activities were reported by smokers between the Intervention and Comparison communities.
The COMMIT intervention had a significant effect on some reported physician behaviours, office practices, and policies. However, most physicians still did not use state-of-the-art smoking intervention practices with their patients and there was little, or no, difference between patient reports of intervention activities of physicians in the Intervention and Comparison communities. Better systems and incentives are needed to attract physicians and their staff to CME and to encourage them to follow through on what they learn. The recently released Agency for Health Care Policy and Research clinical practice guideline for smoking cessation and other standards and policies outline these systems and offer suggestions for incentives to facilitate adoption of these practices by physicians.
比较戒烟社区干预试验（COMMIT）中干预社区和对照社区内科医生及其工作人员的控烟措施。
COMMIT是一项为期四年的随机试验，测试基于社区的戒烟干预措施。
11对匹配的社区，随机分为干预组和对照组。
干预社区的内科医生参加继续医学教育（CME）。针对办公室工作人员的培训重点是控烟和办公室干预“系统”。
22个社区中初级保健医生报告的控烟态度和措施、每个社区30个随机选择的医疗办公室的吸烟政策和措施，以及患者对医生干预活动的报告。
干预社区和对照社区内科医生邮件调查的回复率分别为45%和42%。对办公室工作人员的电话访谈在两种情况下的回复率均为84%。干预社区的内科医生比对照社区的内科医生更有可能参加培训（分别为53%和26%，P<0.0005）。在两种情况下，参加培训者都认为自己比未参加培训者更有准备为吸烟者提供咨询（P≤0.01），并报告在吸烟干预方面有更多活动。干预社区开展了更多基于办公室的控烟活动（P = 0.002）。干预社区的吸烟者更有可能报告从他们的医生那里收到关于吸烟的阅读材料（P = 0.026）。干预社区和对照社区的吸烟者在医生干预活动方面未报告其他差异。
COMMIT干预对一些报告的医生行为、办公室措施和政策有显著影响。然而，大多数医生在对患者进行干预时仍未采用最新的吸烟干预措施，干预社区和对照社区患者对医生干预活动的报告几乎没有差异。需要更好的系统和激励措施来吸引医生及其工作人员参加CME，并鼓励他们将所学知识付诸实践。最近发布的医疗保健政策与研究机构的戒烟临床实践指南以及其他标准和政策概述了这些系统，并提出了激励建议，以促进医生采用这些措施。
