If it is as simple as AAAAA B C, why don't we do it?
If it is as simple as AAAAA B C, why don't we do it?
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如果像AAAAA B C那么简单，我们为什么不这样做呢？
DOI：
10.1007/s11606-008-0896-2
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发表时间：
2009
影响因子：
5.7
通讯作者：
Bastian,LoriA
中科院分区：
文献类型：
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作者：
Bastian,LoriA
2000年，美国公共卫生署发布了一项促进戒烟的临床实践指南，呼吁卫生保健提供者遵循5-A协议：每次访问时询问吸烟情况;建议所有烟草使用者戒烟;评估戒烟尝试的意愿;协助病人戒烟（即帮助设定戒烟日期，参考特殊计划，并根据他们的成瘾程度和习惯开出药物治疗处方）;并于戒烟后一星期内安排跟进联络，以提供进一步协助。2008年更新的指南确认了治疗的有效性，并强调了医疗保健系统在烟草治疗策略成功方面的重要性。2虽然大多数吸烟者是在诊所就诊时发现的，并报告在这些就诊期间接受了建议，但有效的戒烟援助，如咨询和药物治疗，通常没有得到充分利用。3.在扩大现有循证戒烟实践的覆盖面方面，还有很大的改进空间。在最新一期的JGIM中，Quinn等人介绍了在国家癌症研究所资助的癌症研究网络内进行的HMOs调查烟草（HIT）研究的结果。4从9个卫生组织中确定了4,000多名吸烟者。一项为期12个月的随访调查（65%的应答率），在接受过初级保健访问的吸烟者中，评估了吸烟状况和提供者提供的烟草治疗报告。吸烟者更经常得到建议（77%），而不是帮助（33-41%）和安排（13%）。在随访中，9%的人禁欲30天或更长时间。使用课程/咨询或药物治疗（辅助）的吸烟者戒烟的可能性是不使用这些服务的吸烟者的两倍。这些研究结果的主要优势是记录了5-A模型在非研究环境中的利用率和有效性。不幸的是，这些结果是基于患者的报告（1999-2001年收集），并不反映临床医生的观点或病历中的注释。如果它像AAAAA BC一样简单，我们为什么不做呢？Quinn等人的研究强调，使用5-A方案的戒烟治疗部分依赖于提供者的意愿和时间来协助和安排，这可能解释了为什么这些治疗在初级保健中没有得到高度利用。4下一步应包括实施标准化的5-A协议，不依赖于医生，可以由护理或行政人员管理。已经提出了修改的5-A协议（快捷方式）来实现这一目标。在登记时，患者可以接受询问、建议和转诊。5这种转介可能涉及传真到电话戒烟热线或预约护士或药店戒烟诊所。现在在所有50个州都有戒烟热线。与没有咨询相比，这种提供咨询的有效方法使戒烟的几率增加了60%。2因为最成功的治疗方法是联合收割机咨询和药物治疗相结合，所以尼古丁替代疗法处方的标准化方案（无需处方即可获得）也可以由非医生人员管理。另一种可能的方法是询问、建议和电子邮件。6医疗团队的成员可以向患者发送电子邮件，其中包含基于互联网的戒烟计划的链接，或提供持续的电子邮件支持。戒烟治疗可能特别适合于通过互联网提供在线聊天组，公告板，与专家的电子邮件联系，个性化定制的信息和反馈有关的行为技能，解决问题的培训，和.
I n 2000, the US Public Health Service released a clinical practice guideline for promoting smoking cessation that called on health care providers to follow a 5-A protocol: Ask about smoking at every visit; Advise all tobacco users to quit; Assess willingness to make a quit attempt; Assist the patient in quitting (ie, helping set a quit date, referring to a special program, and prescribing pharmacotherapy tailored to their addiction level and habits); and Arrange a follow-up contact within one week after quit date to provide further assistance. 1 The updated 2008 guideline confirmed the effectiveness of treatments and highlighted the importance of the healthcare system in the success of tobacco treatment strategies. 2 Although the majority of smokers are identified at clinic visits and report receiving advice during these visits, effective smoking cessation assistance such as counseling and pharmacotherapy are generally underutilized. 3 There is much room for improvement to increase the reach of existing evidencedbased smoking cessation practices. In the current issue of JGIM, Quinn et al. present findings from HMOs Investigating Tobacco (HIT) study conducted within the National Cancer Institute-funded Cancer Research Network. 4 More than 4,000 smokers were identified from nine HMOs. A 12-month follow-up survey (65% response rate), among smokers who had a primary care visit, assessed smoking status and report of tobacco treatments offered by their provider. Smokers were more often offered Advice (77%) than Assist (33-41%) and Arrange (13%). At follow-up, 9% were abstinent for 30 days or longer. Smokers who used classes/counseling or pharmacotherapy (Assist) were twice as likely to quit compared with smokers not using these services. The major strength of these findings is documenting the utilization and effectiveness of the 5-A model in a non-research setting. Unfortunately, these results are based on reports from patients (collected 1999-2001) and do not reflect the perspective of clinicians or notations from the medical record. If it is as simple as AAAAA BC, why don’t we do it? The study by Quinn et al. highlights that smoking cessation treatment using the 5-A protocol relies, in part, on a provider’s willingness and time to Assist and Arrange which may explain why these treatments are not highly utilized in primary care. 4Next steps should include the implementation of standardized 5-A protocols that do not rely on physicians and can be administered by nursing or administrative staff. Modified 5-A protocols (shortcuts) have been proposed to achieve this goal. At check in, a patient could receive Ask, Advise, and Refer. 5 This referral could involve a fax to a telephone quit line or an appointment for a nurse-based or pharmacy-based smoking cessation clinic. Quit lines are now available in all 50 States. This effective method of providing counseling increases the odds of smoking cessation by 60% compared to no counseling. 2 Because the most successful treatments combine counseling and pharmacotherapy, standardized protocols for prescribing nicotine replacement therapies (available without prescription) could also be administered by non-physician staff. Another potential approach is Ask, Advise, and e-mail. 6 A member of the health care team could send an e-mail to the patient with links to Internet-based smoking cessation programs or offer to provide ongoing e-mail support. Smoking cessation treatment may be particularly well suited to delivery via the Internet through on-line chat groups, bulletin boards, email contacts with experts, individually tailored information and feedback regarding behavioral skills, problem solving training, and …