Interventions for smoking cessation in hospitalised patients.
Interventions for smoking cessation in hospitalised patients.
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DOI：
10.1002/14651858.cd001837.pub3
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发表时间：
2012-05-16
影响因子：
8.4
通讯作者：
Stead, Lindsay F
中科院分区：
文献类型：
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作者：
Rigotti, Nancy A;Clair, Carole;Munafo, Marcus R;Stead, Lindsay F
吸烟是住院的原因之一，住院期间可能是帮助戒烟的好时机。确定住院患者戒烟干预措施的有效性。我们检索了科克伦烟草成瘾组登记册，其中包括2011年12月从CENTRAL、MEDLINE、EMBASE和PsycINFO中识别出的论文，以获得住院患者戒烟干预措施的研究，使用的术语包括（医院和患者 *）或医院 * 或住院 * 或入院 * 或入院。在当前吸烟者或近期戒烟者（定义为入院前戒烟超过1个月）住院患者中进行的帮助患者戒烟的行为、药物或多组分干预的随机和半随机试验。干预必须在医院开始，但可以在出院后继续。我们排除了主要治疗精神疾病或药物滥用的机构收治的患者的研究，没有报告禁欲率的研究以及随访时间少于6个月的研究。急性护理医院和康复医院都包括在这次更新中，对每种类型的医院进行了单独的分析。两名作者为每篇论文独立提取数据，通过协商一致解决分歧。50项试验符合纳入标准。在住院期间开始并在出院后至少一个月内继续支持性接触的强化咨询干预措施增加了出院后的戒烟率（风险比（RR）1.37，95%置信区间（CI）1.27至1.48; 25项试验）。与常规护理相比，出院后接触的特定益处在一个试验子集中发现，所有参与者在医院接受咨询干预，并被随机分配到出院后接触或常规护理。没有发现统计上的显着好处，不太密集的咨询干预。与单独的强化咨询相比，在强化咨询干预中加入尼古丁替代疗法（NRT）可提高戒烟率（RR 1.54，95% CI 1.34 - 1.79，6项试验）。在两项试验中，在强化咨询中加入伐尼克兰的效果不显著（RR 1.28，95% CI 0.95至1.74）。添加安非他酮与单独强化咨询相比，没有产生统计学显著的戒烟增加（RR 1.04，95%CI 0.75至1.45，3项试验）。在因心血管疾病（CVD）住院的吸烟者亚组中观察到类似的结果。在这个亚组中，强化干预和随访支持增加了戒烟率（RR 1.42，95%CI 1.29至1.56），但不太强化的干预没有。一项强化干预试验，包括对因心血管疾病入院的吸烟者进行咨询和药物治疗，评估了临床和医疗保健利用终点，发现在两年的随访期内，全因死亡率和再入院率显着降低。这些试验均在急性护理医院进行。在对康复医院的强化咨询干预进行的单独汇总分析中，观察到戒烟率有相当的增加（RR 1.71，95% CI 1.37至2.14，3项试验）。在住院期间开始的高强度行为干预，包括出院后至少一个月的支持性接触，可促进住院患者戒烟。无论患者的入院诊断如何，这些干预措施都是有效的，并且在康复机构以及急性护理医院中都是有效的。在这种情况下，较低强度或较短持续时间的干预并未显示出有效性。这一更新发现，将NRT添加到强化咨询中比单独咨询显著增加了戒烟率。没有足够的直接证据表明，在强化咨询中加入安非他酮或伐尼克兰比单独咨询更能提高戒烟率。
Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting. To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted to facilities that primarily treat psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow-up of less than six months. Both acute care hospitals and rehabilitation hospitals were included in this update, with separate analyses done for each type of hospital. Two authors extracted data independently for each paper, with disagreements resolved by consensus. Fifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48; 25 trials). A specific benefit for post-discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post-discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non-significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. These trials were all conducted in acute care hospitals. A comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. These interventions are effective regardless of the patient's admitting diagnosis and are effective in rehabilitation settings as well as acute care hospitals. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone.