A survey of managed care strategies for pregnant smokers
A survey of managed care strategies for pregnant smokers
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怀孕吸烟者管理式护理策略的调查
作者：
D. Barker;L. Robinson;A. Rosenthal
目的 本研究的目的是衡量管理式医疗组织 (MCO) 内妊娠期特定戒烟策略的内容和全面性，该组织对 1997-98 年全国管理式医疗中解决烟草问题 (ATMC) 调查做出了积极回应。设计 这项横断面跟踪研究包括发送给医疗主管的传真调查和针对项目监督者的关于戒烟策略的 37 个问题电话调查。对象 147 个 MCO 在 1997-98 年 ATMC 调查中确定了妊娠期特定戒烟策略，作为初始样本； 128 个合格计划中的 88 个 MCO 完成了这两个部分，响应率为 69%。结果 怀孕期间特定的戒烟策略各不相同。 40% 的受访者使用卫生保健政策和研究机构的临床戒烟指南来设计他们的策略。策略包括自助材料、退学、电话支持和提供者的简短咨询、与质量改进工作的联系以及使用患者数据库进行外展。只有 42% 的受访者提供了预防产后复发的内容。缺乏患者兴趣、相互竞争的诊所优先事项以及缺乏吸烟者识别系统是实施策略的最大障碍，至少四分之一的受访者普遍存在这种情况。大多数人将最佳实践手册和网站链接列为最有用的技术援助形式，其次是同行咨询、区域研讨会、新闻通讯、现场援助和国家会议。结论 该调查首次提供了管理式护理中产前烟草治疗策略的概况。虽然设计限制阻碍了将这些结果推广到所有 MCO，但此类信息可以帮助指导对减少孕妇吸烟的计划的技术援助。
OBJECTIVE The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. DESIGN This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. SUBJECTS 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. RESULTS Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. CONCLUSIONS The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.