Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study)
Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study)
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DOI：
10.1111/j.1360-0443.2011.03491.x
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发表时间：
2011-09-01
期刊：
影响因子：
6
通讯作者：
Martin, Carlos
中科院分区：
文献类型：
--
作者：
Cabezas, Carmen;Advani, Mamta;Martin, Carlos
目的基于改变的跨理论模型评价阶梯式戒烟干预在基层保健中的效果。设计整群随机试验；随机单位：基本护理单位(照顾同一组患者的家庭医生和护士)；意向治疗分析。建立所有感兴趣的基本护理单位(n=176)，这些单位在西班牙13个地区的82个初级保健中心工作，属于西班牙预防服务和健康促进研究网络。参与者共有2827名吸烟者(年龄14-85岁)，他们以任何原因咨询初级保健中心，提供书面知情同意，并进行了有效的访谈。测量结果变量为随访2年时的1年持续戒毒率。主要变量为研究组(干预/对照)。干预包括6个月实施临床实践指南中的建议，包括在预想-沉思阶段对吸烟者进行简短的动机访谈，对不需要帮助的准备-行动阶段的吸烟者进行简短干预，对准备-行动阶段的吸烟者进行药物治疗的强化干预，以及在维持阶段加强干预。对照组采用常规护理。此外，还收集了烟草使用特征和戒烟动机变量。结果干预组1年持续戒断率为8.1%，对照组为5.8%(P=0.014)。在多因素Logistic回归分析中，干预组与对照组的戒烟比为1.50(95%可信区间=1.05~2.14)。结论：基于跨理论模型的阶梯式戒烟干预显著增加了去初级保健中心的吸烟者在2年随访中的戒烟率。
Aim To evaluate the effectiveness in primary care of a stepped smoking cessation intervention based on the trans-theoretical model of change. Design Cluster randomized trial; unit of randomization: basic care unit (family physician and nurse who care for the same group of patients); and intention-to-treat analysis. Setting All interested basic care units (n = 176) that worked in 82 primary care centres belonging to the Spanish Preventive Services and Health Promotion Research Network in 13 regions of Spain. Participants A total of 2827 smokers (aged 14-85 years) who consulted a primary care centre for any reason, provided written informed consent and had valid interviews. Measurements The outcome variable was the 1-year continuous abstinence rate at the 2-year follow-up. The main variable was the study group (intervention/control). Intervention involved 6-month implementation of recommendations from a Clinical Practice Guideline which included brief motivational interviews for smokers at the precontemplation-contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help and reinforcing intervention in the maintenance stage. Control group involved usual care. Among others, characteristics of tobacco use and motivation to quit variables were also collected. Findings The 1-year continuous abstinence rate at the 2-year follow-up was 8.1% in the intervention group and 5.8% in the control group (P = 0.014). In the multivariate logistic regression, the odds of quitting of the intervention versus control group was 1.50 (95% confidence interval = 1.05-2.14). Conclusions A stepped smoking cessation intervention based on the transtheoretical model significantly increased smoking abstinence at a 2-year follow-up among smokers visiting primary care centres.