Barriers to Implementing Evidence-Based Smoking Cessation Practices in Nine Community Mental Health Sites
Barriers to Implementing Evidence-Based Smoking Cessation Practices in Nine Community Mental Health Sites
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DOI：
10.1176/appi.ps.201200247
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发表时间：
2014-01-01
影响因子：
3.8
通讯作者：
Goldman, Howard H.
中科院分区：
文献类型：
--
作者：
Himelhoch, Seth;Riddle, Julia;Goldman, Howard H.
目的：指南强烈建议患有精神疾病的吸烟者接受与普通人群吸烟者类似的循证戒烟干预措施。本研究的目的是评估在心理健康环境中使用这些循证干预措施的资源、障碍和意愿。方法：对马里兰州4个县9个社区精神卫生机构（5个社会心理康复项目和4个社区精神卫生诊所）的临床医生进行调查。问卷-循证实践态度量表-15-评估了戒烟评估和治疗的可用性、障碍和利用情况，包括使用循证实践的意愿。结果：95名临床医生参与了本研究。大多数是全职员工（84%），拥有硕士学位（56%）。绝大多数是不吸烟者或曾经吸烟者（94%）。不到一半（42%）的临床医生报告询问他们的病人吸烟的问题。不到三分之一（33%）建议或协助戒烟。很少有人（10%）报告将已确认的吸烟者介绍给电话戒烟热线。约四分之一（26%）的人表示对自己提供戒烟咨询的能力有信心。提供戒烟咨询的一个主要障碍是认为患者对戒烟不感兴趣（77%）。平均而言，临床医生报告说，如果他们接受了适当的培训，他们非常愿意使用基于证据的戒烟干预措施。结论：在社区精神卫生机构工作的精神卫生临床医生并未始终如一地提供基于证据的戒烟干预措施。障碍似乎可以通过培训和教育加以改变。
Objective: Guidelines strongly recommend that smokers with mental illness receive evidence-based smoking cessation interventions similar to those provided to smokers in the general population. The goal of this study was to evaluate the resources, barriers, and willingness to use these evidence-based interventions in mental health settings. Methods: Clinicians at nine community mental health settings (five psychosocial rehabilitation programs and four community mental health clinics) in four counties in Maryland were surveyed. The questionnaire-the Evidence-Based Practice Attitude Scale-15-evaluated availability, barriers, and utilization of smoking cessation assessment and treatment, including willingness to use evidence-based practices. Results: Ninety-five clinicians participated in the study. Most were full-time employees (84%) with master's degrees (56%). The vast majority were nonsmokers or former smokers (94%). Less than half (42%) of the clinicians reported asking their patients about smoking. Less than a third (33%) advised or assisted in smoking cessation. Very few (10%) reported referring identified smokers to telephone quitlines. About a quarter (26%) reported being confident about their ability to provide smoking cessation counseling. A major barrier to providing cessation counseling was the belief that patients were not interested in quitting (77%). On average, clinicians reported a great willingness to use evidence-based smoking cessation interventions if they received appropriate training. Conclusions: Mental health clinicians working in community mental health settings were not consistently providing evidence-based smoking cessation interventions. Barriers appear to be modifiable through training and education.