Training physicians to do office-based smoking cessation increases adherence to PHS guidelines.
Training physicians to do office-based smoking cessation increases adherence to PHS guidelines.
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DOI：
10.1007/s10900-010-9303-0
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发表时间：
2011-04
影响因子：
5.9
通讯作者：
Blumenthal, Daniel S.
中科院分区：
文献类型：
--
作者：
Caplan, Lee;Stout, Charlotte;Blumenthal, Daniel S.
在美国，吸烟是可预防的死亡和发病的主要原因。医疗保健提供者可以为反对烟草使用的战争做出重大贡献;医生建议戒烟的患者戒烟的可能性是没有接受医生建议的患者的1.6倍。然而，大多数吸烟者在看医生时没有得到这些建议。莫尔豪斯医学院烟草控制研究计划的目的是制定最佳实践，以实施“2000年公共卫生服务关于治疗烟草使用和依赖的临床实践指南”和“自由之路”戒烟计划，在私人执业的非裔美国医生和社区卫生中心的医疗保健提供者中实施。进行了10个焦点小组; 82名医疗保健专业人员参加。六大主题被确定为提供戒烟服务的障碍。根据这些结果制定了干预措施，并在格鲁吉亚社区医生中进行了测试。干预前后共提取308张图表。使用一个系统对图表进行评分，该系统对患者访视期间采用的PHS指南（询问、建议、评估、协助、安排）推荐的五个“A”中的每一个给予一分。干预前的平均五个“A”评分为1.29，干预后为1.90（P < 0.001）。所有图表都有证据表明第一个“A”（“问”）在干预前和干预后，其他四个“A”在干预前和干预后都有统计学上的显著增加。结果表明，通过对医生的培训，可以大大提高对PHS烟草指南的遵守。
Cigarette Smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the “2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence” and the “Pathways to Freedom” tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five “A’s” recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five “A’s” score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first “A” (“asked”) both pre- and post-intervention, and the other four “A’s” all had statistically significant increases pre-to post-intervention. The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.
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