Goldstein M G, DePue J D, Monroe A D, Lessne C W, Rakowski W, Prokhorov A, Niaura R, Dubé C E
Department of Psychiatry and Human Behavior, The Miriam Hospital and Brown University School of Medicine, Providence, Rhode Island, 02906, USA.
Prev Med. 1998 Sep-Oct;27(5 Pt 1):720-9. doi: 10.1006/pmed.1998.0350.
To be most effective, physicians' smoking cessation interventions must go beyond advice, to include counseling and follow-up. A full profile of physician performance on the recommended activities to promote smoking cessation has not been provided previously.
We surveyed a representative sample of 246 community-based primary care physicians who had agreed to participate in a 3-year study to evaluate a strategy for disseminating smoking cessation interventions, based on the National Cancer Institute 4-A model and on the Transtheoretical Model of Change.
A majority reported they Ask (67%) and Advise (74%) their patients about smoking, while few go beyond to Assist (35%) or Arrange follow-up (8%) with patients who smoke. The criteria for "thorough" counseling was met by only 27% of physicians. More than half were not intending to increase counseling activity in the next 6 months. After controlling for other variables, physicians in private offices were more likely than physicians in HMO or other settings to be active with smoking cessation counseling. General Internal Medicine physicians were most active, and Ob/Gyn physicians were least active, with smoking cessation counseling among primary care specialty groups.
Innovative approaches are needed to motivate, support, and reward physicians to counsel their patients who smoke, especially when considering the movement toward managed health care.
A survey of primary care physicians focusing on national guidelines for smoking cessation counseling showed a majority Ask (67%) and Advise (74%) patients about smoking, but few Assist (35%) or Arrange follow-up (8%).
为了达到最佳效果，医生的戒烟干预措施必须超越单纯的建议，要包括咨询和随访。此前尚未提供医生在推荐的促进戒烟活动方面的完整表现概况。
我们对246名社区基层医疗医生进行了一项代表性抽样调查，这些医生同意参与一项为期3年的研究，以评估基于美国国立癌症研究所4 - A模式和跨理论转变模型的戒烟干预措施传播策略。
大多数医生报告称他们会询问（67%）并建议（74%）患者关于吸烟的问题，而对于吸烟患者很少会进一步提供帮助（35%）或安排随访（8%）。只有27%的医生符合“全面”咨询的标准。超过一半的医生不打算在未来6个月内增加咨询活动。在控制其他变量后，私人诊所的医生比健康维护组织（HMO）或其他机构的医生更有可能积极开展戒烟咨询。在基层医疗专科组中，普通内科医生开展戒烟咨询最为积极，妇产科医生最不积极。
需要创新方法来激励、支持和奖励医生为吸烟患者提供咨询，尤其是考虑到向管理式医疗保健的转变趋势。
一项针对基层医疗医生的调查聚焦于戒烟咨询的国家指南，结果显示大多数医生会询问（67%）并建议（74%）患者关于吸烟的问题，但很少提供帮助（35%）或安排随访（8%）。
