A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use
A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use
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DOI：
10.1093/ntr/ntx204
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发表时间：
2018-10-01
影响因子：
4.7
通讯作者：
Sherman，Scott E.
中科院分区：
文献类型：
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作者：
Rogers，Erin S.;Gillespie，Colleen;Sherman，Scott E.
患有精神健康障碍的退伍军人吸烟率高，但烟草治疗率低。我们试图了解在退伍军人精神卫生诊所治疗烟草使用的障碍和促进因素。方法本定性研究是一项试验的一部分，该试验评估了六个退伍军人事务部设施中使用心理健康服务的吸烟者的电话护理协调计划。我们对14名工作人员进行了半结构化访谈：12名在父母研究干预点工作的心理健康诊所工作人员（n= 6名精神病学家，3名心理学家，2名社会工作者，1名NP），以及退伍军人事务部国家烟草咨询委员会的一名精神病学家和一名心理学家。采访被转录和归纳编码，以确定主题。结果出现了5个“障碍”主题：(1)优先事项竞争；(2)患者挑战/阻力；(3)人员配置复杂/跨学科协调困难；(4)对烟草是否属于精神卫生保健责任的看法不一；(5)工作人员在烟草治疗方面的培训/安慰有限。出现了五个“促进者”主题：(1)提醒精神卫生工作人员注意烟草；(2)工作人员相信解决烟草问题的重要性；(3)指定戒烟药物处方者；(4)将烟草与精神卫生结果和规范联系起来；(5)限制精神卫生工作人员的负担。结论va精神卫生人员不知道烟草使用的重要性，但他们面临竞争的优先事项，遇到患者的抵制，在解决烟草问题方面的角色存在冲突，并且缺乏烟草培训。他们提出了有助于克服这些障碍的多层次战略，这些战略可用于设计干预措施，改善对精神健康患者的烟草治疗。这项研究建立在现有文献的基础上，即在患有精神疾病的人群中，吸烟率高，但治疗率低。本研究是为数不多的心理健康诊所工作人员对治疗烟草障碍和促进因素的看法的定性评估之一。研究结果为制定策略以改善心理健康诊所烟草治疗方案的实施提供了一个多层次的框架。
IntroductionVeterans with mental health disorders smoke at high rates, but encounter low rates of tobacco treatment. We sought to understand barriers and facilitators to treating tobacco use in VA mental health clinics.MethodsThis qualitative study was part of a trial evaluating a telephone care coordination program for smokers using mental health services at six VA facilities. We conducted semi-structured interviews with 14 staff: 12 mental health clinic staff working at the parent study’s intervention sites (n= 6 psychiatrists, three psychologists, two social workers, one NP), as well as one psychiatrist and one psychologist on the VA’s national tobacco advisory committee. Interviews were transcribed and inductively coded to identify themes.ResultsFive “barriers” themes emerged: (1) competing priorities, (2) patient challenges/resistance, (3) complex staffing/challenging cross-discipline coordination, (4) mixed perceptions about whether tobacco is a mental health care responsibility, and (5) limited staff training/comfort in treating tobacco. Five “facilitators” themes emerged: (1) reminding mental health staff about tobacco, (2) staff belief in the importance of addressing tobacco, (3) designating a cessation medication prescriber, (4) linking tobacco to mental health outcomes and norms, and (5) limiting mental health staff burden.ConclusionsVA mental health staff struggle with knowing that tobacco use is important, but they face competing priorities, encounter patient resistance, are conflicted on their role in addressing tobacco, and lack tobacco training. They suggested strategies at multiple levels that would help overcome those barriers that can be used to design interventions that improve tobacco treatment delivery for mental health patients.ImplicationsThis study builds upon the existing literature on the high rates of smoking, but low rates of treatment, in people with mental health diagnoses. This study is one of the few qualitative evaluations of mental health clinic staff perceptions of barriers and facilitators to treating tobacco. The study results provide a multi-level framework for developing strategies to improve the implementation of tobacco treatment programs in mental health clinics.