Incentivising, facilitating, and implementing an office tobacco cessation system
Incentivising, facilitating, and implementing an office tobacco cessation system
复制标题
激励、促进和实施办公室戒烟系统
DOI：
10.1136/tc.9.suppl_1.i37
复制
发表时间：
2000
期刊：
影响因子：
5.2
通讯作者：
L. Solberg
中科院分区：
文献类型：
--
作者：
L. Solberg
尽管美国卫生保健政策和研究机构（AHCPR）制定并出版了一份全国性的基于证据的戒烟临床指南，明确了在医疗实践中应该使用的方法，但临床医生要始终如一地遵循它还有很长的路要走。2-7克伦威尔等人研究了应用AHCPR指南中建议的成本效益，并得出结论，每个质量调整生命年的成本为1915美元，这是所有预防性服务中最具成本效益的服务之一
Although the development and publication of a national evidence based clinical guideline for smoking cessation from the Agency for Health Care Policy and Research (AHCPR)1 has clarified the approach that should be used in medical practice settings, clinicians are still a long way from following it consistently.2-7 Cromwell et al have studied the cost effectiveness of applying the recommendations in the AHCPR guideline and concluded that at $1915 per quality adjusted life year, it is one of the most cost effective of all preventive services.8
However, if we are to realise the potential that clinicians have to facilitate cessation and achieve these health and life gains, we shall have to find some way to make large changes in the current behaviour of clinicians. One of the obvious resources for stimulating this type of change is the managed care health plans that have contracts with most of the primary care clinics in the country.9 If the excess medical costs of smokers to the age of 65 years are really $9000 to $11 000,10 Cromwell calculates that the medical care savings per quitter should average about $6000 per quitter.8 If so, and if health plans could count on enough member continuity to achieve some portion of those savings, they would have a real incentive to try to change clinician behaviour in this area.
Fortunately, it is now also becoming clear what types of changes will lead to more effective implementation of this guideline. As with the implementation of any guideline, simple educational efforts will have little effect.11 12 Instead, office systems that start with making identification of smoking status a vital sign are clearly the key to consistent adherence to the guideline.13-20
Thus, the question becomes what can a health plan do to try to …
一项旨在增加医生吸烟干预的随机试验。
DOI：
--
发表时间：
1989
期刊：
JAMA
影响因子：
--
作者：
Kottke,TE;Brekke,ML;Solberg,LI;Hughes,JR
通讯作者：
Hughes,JR
培训和结构化办公室实践对医生提供的营养咨询的影响：伍斯特地区高脂血症咨询试验 (WATCH)。
DOI：
--
发表时间：
1996
期刊：
American journal of preventive medicine.
影响因子：
--
作者：
Ockene,IS;Hebert,JR;Ockene,JK;Merriam,PA;Hurley,TG;Saperia,GM
通讯作者：
Saperia,GM
基于初级保健办公室的系统性戒烟计划。
DOI：
--
发表时间：
1990
期刊：
The Journal of family practice
影响因子：
--
作者：
Solberg,LI;Maxwell,PL;Kottke,TE;Gepner,GJ;Brekke,ML
通讯作者：
Brekke,ML