Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center.
Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center.
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DOI：
10.1097/md.0000000000001903
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发表时间：
2015-11
期刊：
影响因子：
1.6
通讯作者：
Hays JT
中科院分区：
文献类型：
--
作者：
Burke MV;Ebbert JO;Schroeder DR;McFadden DD;Hays JT
吸烟导致过早死亡和多重发病；戒烟能增进健康。更高的戒烟率可以通过更强化的治疗来实现，包括药物治疗和对患者的长期咨询，但将这些干预措施纳入医疗保健服务系统存在挑战。一种护理模式使用经过烟草治疗专家培训的大师级咨询师提供行为干预，与监督医生/开处方者合作，提供了将更密集的烟草依赖治疗纳入医院、诊所和其他医疗系统的机会。这篇文章分析了在一个大型门诊诊所使用tts医生团队治疗的吸烟者戒烟的治疗结果和预测因素，为期7年。这是一项观察性研究，研究对象是在医疗中心接受烟草依赖治疗的一大群吸烟者。由初级保健小组转介进行TTS咨询的患者接受了由工作手册指导的标准评估和个性化治疗计划。与每位患者合作制定药物和行为计划。在初步评估六个月后，通过电话确定了7天的自我报告禁欲期。使用卡方检验评估每个基线患者特征与6个月时自我报告的烟草戒断的单变量关联。此外，以自我报告的戒烟情况为因变量，并将所有基线特征作为解释变量，进行多元logistic回归分析。在7年期间（2005-2011年），6824名提供一般研究授权的吸烟者接受了治疗。6个月自我报告戒断率为28.1%（95%可信区间：27.7-30.1）。最有可能报告戒断的患者依赖程度较低，更有动力戒烟，并且在过去一年中没有抑郁症或酗酒的诊断。可预测的患者特征（如依赖程度）确实预测了戒断，但所有患者组的戒断结果都是相似的。虽然本研究存在单中心回顾性队列研究固有的局限性，但它确实表明TTS模型是将更密集的烟草依赖治疗整合到门诊环境中的有效方法。
Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervising physician/prescriber, affords an opportunity to integrate more intensive tobacco dependence treatment into hospitals, clinics, and other medical systems. This article analyzes treatment outcomes and predictors of abstinence for cigarette smokers being treated using the TTS-physician team in a large outpatient clinic over a 7-year period. This is an observational study of a large cohort of cigarette smokers treated for tobacco dependence at a medical center. Patients referred by the primary healthcare team for a TTS consult received a standard assessment and personalized treatment planning guided by a workbook. Medication and behavioral plans were developed collaboratively with each patient. Six months after the initial assessment, a telephone call was made to ascertain a 7-day period of self-reported abstinence. The univariate association of each baseline patient characteristic with self-reported tobacco abstinence at 6 months was evaluated using the chi-squared test. In addition, a multiple logistic regression analysis was performed with self-reported tobacco abstinence as the dependent variable and all baseline characteristics included as explanatory variables. Over a period of 7 years (2005–2011), 6824 cigarette smokers who provided general research authorization were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95% confidence interval: 27.7–30.1). The patients most likely to report abstinence were less dependent, more motivated to quit, and did not have a past year diagnosis of depression or alcoholism. Predictable patient characteristics such as level of dependence did predict abstinence, but all patient groups achieved comparable abstinence outcomes. While this study has limitations inherent in a single-center retrospective cohort study, it does suggest that the TTS model is an effective way to integrate more intensive tobacco dependence treatment into outpatient settings.