Have Guidelines About Smoking Cessation Support in Pregnancy Changed Practice in Victoria, Australia?
Have Guidelines About Smoking Cessation Support in Pregnancy Changed Practice in Victoria, Australia?
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DOI：
10.1111/birt.12036
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发表时间：
2013-06-01
影响因子：
2.5
通讯作者：
Yelland, Jane
中科院分区：
文献类型：
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作者：
Perlen, Susan;Brown, Stephanie J.;Yelland, Jane
背景在过去的十年里，澳大利亚维多利亚州已经有了产前戒烟指南。这项研究的目的是评估在怀孕期间引入戒烟指南在多大程度上改变了维多利亚公立医院的做法。方法2000年和2008年，在实施戒烟指南前后，对维多利亚州分娩的妇女进行了两次以人口为基础的邮寄调查。产后5~6个月由医院和家庭分娩医师自行发放问卷。结果2000年和2008年分别有67%(1 616/2 412)和51%(2 900/5 681)的合格妇女完成了调查并返回。与2000年的调查相比，在2008年的调查中，参加公共部门护理的女性更有可能接受关于如何戒烟的建议(调整后的优势比：2.2，95%CI 1.5~3.2)；得到书面信息(调整OR：2.7，95%CI 1.8~4.0)；被转介到戒烟计划(调整OR：6.1，95%CI 3.1~11.7)；以及在一次以上的就诊中讨论过戒烟(调整OR：1.5，95%CI 1.0~2.2)。虽然在这两项调查中，大多数女性都被问及在怀孕早期吸烟的问题，但约有一半的吸烟者没有收到如何戒烟或戒烟的建议；没有得到书面信息；没有被告知/推荐戒烟计划，也没有在以后的就诊中再次被问及吸烟的问题。在两次调查之间，妇女接受戒烟建议和支持的报告发生了重大变化，主要发生在公立医院，妇女在那里接受全部或部分产前护理。结论维多利亚州公立医院的戒烟指南增加了孕妇接受戒烟或减少吸烟的建议和支持的程度。然而，根据国家指导方针，一半的吸烟者没有得到充分的建议和支持，根据妇女在哪里和从谁那里接受产前护理，有明显的差异。需要进一步努力将戒烟建议和支持落实到临床实践中。
Background Antenatal smoking cessation guidelines have been available in Victoria, Australia, for the past decade. The objective of this study was to assess to what extent introduction of smoking cessation guidelines in pregnancy changed practice in Victorian public hospitals. Methods Two population-based postal surveys of women giving birth in the state of Victoria, conducted in 2000 and 2008 before and after implementation of smoking cessation guidelines. Self-administered questionnaires were distributed by hospitals and home birth practitioners to women 5-6months postpartum. Results Surveys were completed and returned by 67 percent of eligible women (1,616/2,412) in 2000 and 51% (2,900/5,681) in 2008. Compared with the 2000 survey, women in the 2008 survey attending public sector care were more likely: to receive advice on how to stop smoking (Adjusted Odds Ratio: 2.2, 95% CI 1.5-3.2); to be given written information (Adj OR: 2.7, 95% CI 1.8-4.0); to be referred to stop smoking programs (Adj OR: 6.1, 95% CI 3.1-11.7); and to have discussed smoking cessation at more than one visit (Adj OR: 1.5, 95% CI 1.0-2.2). While the majority of women in both surveys were asked about smoking in early pregnancy, about half of those smoking did not receive advice on how to stop or cut down; were not given written information; were not told about/referred to stop smoking programs and were not asked again about smoking at subsequent visits. The significant shift in women's reports of receiving smoking cessation advice and support between the two surveys occurred predominantly at public hospitals where women received all or some antenatal care. Conclusions Smoking cessation guidelines in Victorian public hospitals have increased the extent to which pregnant women receive advice and support to stop or reduce smoking. However, half of smokers did not receive the full complement of advice and support according to state guidelines, with marked variability according to where and from whom women received antenatal care. Further efforts are needed to implement smoking cessation advice and support in clinical practice.