Efficacy of resident training in smoking cessation:: A randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients
Efficacy of resident training in smoking cessation:: A randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients
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DOI：
10.7326/0003-4819-136-6-200203190-00006
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发表时间：
2002-03-19
影响因子：
39.2
通讯作者：
Pécoud, A
中科院分区：
文献类型：
--
作者：
Cornuz, J;Humair, JP;Pécoud, A
背景：必须制定新的教育计划，以提高医生咨询患者戒烟的技能和有效性。目的：评估基于行为理论、主动学习方法和标准化患者实践的教育计划在帮助患者戒烟和改变医生咨询实践方面的效果。设计：整群随机对照试验。地点：瑞士的两个普通内科诊所。参与者：35 名居民和 251 名连续吸烟患者。干预：为期两个半天的培训计划，在此期间，医生学会提供与吸烟者戒烟动机相匹配的咨询，并在不同变化阶段扮演吸烟者的标准化患者练习这些技能。控制干预是关于血脂异常管理的教学课程。测量：随访 1 年时自我报告的戒烟情况，通过一家诊所的呼出一氧化碳测试进行验证；基于14种咨询策略的使用的咨询整体质量得分；患者有戒烟意愿；结果：随访 1 年时，干预组的戒烟率显着高于对照组（13% vs. 5%；P = 0.005）；这对应于集群调整优势比 2.8（95% Cl，1.4 至 5.5）。接受研究培训的住院医师比接受对照培训的住院医师提供了更好的咨询（平均分，4.0 vs. 2.7；P = 0.002）。干预组中吸烟者的戒烟意愿也较高（94% vs. 80%；P = 0.007）。干预组中观察到每日吸烟量下降的趋势不显着。结论：基于行为理论和标准化患者实践的医生戒烟培训计划显着提高了医生咨询的质量、吸烟者的戒烟动机以及一年内的戒烟率。
Background:New educational programs must be developed to improve physicians' skills and effectiveness in counseling patients about smoking cessation.Objective: To assess the efficacy of an educational program based on behavioral theory, active learning methods, and practice with standardized patients in helping patients abstain from smoking and changing physicians' counseling practices.Design: Cluster randomized, controlled trial.Setting: Two general internal medicine clinics in Switzerland.Participants: 35 residents and 251 consecutive smoking patients. Intervention: A training program administered over two half-days, during which physicians learned to provide counseling that matched smokers' motivation to quit and practiced these skills with standardized patients acting as smokers at different stages of change. The control intervention was a didactic session on management of dyslipidemia.Measurements: Self-reported abstinence from smoking at 1 year of follow-up, which was validated by exhaled carbon monoxide testing at one clinic; score of overall quality of counseling based on use of 14 counseling strategies; patient willingness to quit; and daily cigarette consumption.Results: At 1 year of follow-up, abstinence from smoking was significantly higher in the intervention group than in the control group (13% vs. 5%; P = 0.005); this corresponded to a cluster-adjusted odds ratio of 2.8 (95% Cl, 1.4 to 5.5). Residents who received the study training provided better counseling than did those who received the control training (mean score, 4.0 vs. 2.7; P = 0.002). Smokers' willingness to quit was also higher in the intervention group (94% vs. 80%; P = 0.007). A nonsignificant trend toward lower daily cigarette consumption in the intervention group was observed.Conclusion: A training program in smoking cessation administered to physicians that was based on behavioral theory and practice with standardized patients significantly increased the quality of physicians' counseling, smokers' motivation to quit, and rates of abstinence from smoking at 1 year.