A survey of tobacco dependence treatment guidelines in 31 countries
A survey of tobacco dependence treatment guidelines in 31 countries
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DOI：
10.1111/j.1360-0443.2009.02584.x
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发表时间：
2009-07-01
期刊：
影响因子：
6
通讯作者：
McNeill, Ann
中科院分区：
文献类型：
--
作者：
Raw, Martin;Regan, Susan;McNeill, Ann
《烟草控制框架公约》（FCTC）要求各国制定和传播全面的循证指南，并促进对烟草依赖的充分治疗，但迄今为止尚无现有指南内容的摘要。本文描述了 31 个国家的国家烟草依赖治疗指南。2007 年，通过电子邮件向 31 个国家从事烟草控制工作的联系人发送了一份关于烟草依赖治疗指南的调查问卷。从所有 31 个国家的受访者那里收到了完整的调查问卷。在这些调查过程中，我们还联系了 14 个没有治疗指南的国家的人们，并向他们发送了一份简短的调查问卷，询问他们制定指南的计划。调查工具是一份包含 17 项的调查问卷，询问以下关键问题：指南是否建议简短的干预措施、强化行为支持、药物治疗？哪些药物；这些指南是否适用于整个医疗保健系统和所有专业人员？他们是否明确引用 Cochrane 数据库？它们是否基于另一个国家的指导方针？它们是全国性的还是地方性的；它们是否得到政府正式认可？他们是否经过同行评审？谁资助了他们；它们在哪里出版；它们是否包括治疗成本效益的证据？据受访者称，所有国家的指南均推荐简短建议、强化行为支持和尼古丁替代疗法（NRT）； 84%推荐安非他酮； 19%推荐伐尼克兰； 35% 的人建议拨打戒烟热线。近一半（48%）包含成本效益证据。 71% 得到政府的正式支持，65% 得到政府的财政支持。大多数（84%）使用 Cochrane 综述作为证据来源，84% 接受了同行评审过程，55% 基于其他国家（最常见的是美国和英国）的指南。总体而言，审查的指南严格遵循证据基础，建议简短的干预措施、强化行为支持和 NRT，最推荐的是安非他酮。本次调查中的大多数国家在编写指南时伐尼克兰尚未上市，这说明需要定期更新指南。没有人推荐未证明有效的干预措施，有些人明确建议反对特定干预措施（由于缺乏证据）。大多数都经过了同行评审，许多都经过了漫长而严格的程序，而且大多数都得到了政府的正式认可或支持。一些没有指南的国家表示需要技术支持，强调各国需要分享经验，而《烟草控制框架公约》进程可以很好地支持这一点。
The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence-based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes the national tobacco dependence treatment guidelines of 31 countries.A questionnaire on tobacco dependence treatment guidelines was sent by e-mail to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines.The survey instrument was a 17-item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole health-care system and all professionals; do they refer explicitly to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they endorsed formally by government; did they undergo peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment?According to respondents, all their countries' guidelines recommended brief advice, intensive behavioural support and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost-effectiveness evidence. Seventy-one per cent were supported formally by their government and 65% were supported financially by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% underwent a peer review process and 55% were based on the guidelines of other countries, most often the United States and England.Overall, the guidelines reviewed followed the evidence base closely, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be updated periodically. None recommended interventions not proven to be effective, and some recommended explicitly against specific interventions (for lack of evidence). Most were peer-reviewed, many through lengthy and rigorous procedures, and most were endorsed or supported formally by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasizing the need for countries to share experience, something the FCTC process is well placed to support.