Management of smokers motivated to quit: a qualitative study of smokers and GPs.
Management of smokers motivated to quit: a qualitative study of smokers and GPs.
复制标题
吸烟者戒烟动机的管理：对吸烟者和全科医生的定性研究。
DOI：
10.1093/fampra/cmq027
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发表时间：
2010
期刊：
影响因子：
2.2
通讯作者：
Julia Chernova
中科院分区：
文献类型：
--
作者：
A. Wilson;Shona Agarwal;S. Bonas;G. Murtagh;T. Coleman;N. Taub;Julia Chernova
背景
美国国家健康与临床优化研究所（NICE）的指南指出，全科医生应该通过提供戒烟服务（SSS）来管理有戒烟动机的吸烟者，尼古丁成瘾治疗（NAT）应该只提供给那些拒绝转诊的人。
目的
探讨如何在全科医生咨询中管理有戒烟动机的吸烟者，特别是如何从双方的角度协商治疗和转诊。
方法
20例患者，确定在咨询与他们的家庭医生戒烟的动机，和10个参与的家庭医生进行了采访。采用框架方法对访谈进行了记录、转录、编码和分析。
结果
三种策略（GP治疗和随访、不治疗的SSS转诊和转诊随访的立即治疗）在患者和GP账户中得到证实。大多数患者对他们的管理和谈判方式感到满意，但有些患者对缺乏立即治疗表示惊讶或不满，并质疑是否需要转诊到SSS。全科医生欢迎SSS的可用性，但有些人认为重要的是，他们自己也继续支持戒烟尝试。一些人认为在患者有动力停止时提供NAT有优势。
结论
吸烟者似乎不太相信比全科医生的价值转介到SSS，虽然这些差异可能会通过谈判解决。NICE提出的替代策略可能更容易被一些吸烟者接受，即立即治疗，随后由SSS提供支持。
BACKGROUND
The National Institute for Health and Clinical Excellence (NICE) guidelines state that GPs should manage smokers motivated to quit by offering referral to Stop Smoking Services (SSS) and that nicotine addiction treatment (NAT) should be offered only to those who decline referral.
OBJECTIVE
To explore how smokers motivated to quit are managed in the GP consultation, specifically how treatment and referral are negotiated from the perspectives of both parties.
METHODS
Twenty patients, identified in a consultation with their GP as motivated to quit smoking, and 10 participating GPs were interviewed. Interviews were recorded, transcribed, coded and analysed using the framework approach.
RESULTS
Three strategies (treatment and follow-up by the GP, referral to SSS without treatment and immediate treatment with referral for follow-up) were evidenced in patient and GP accounts. Most patients were satisfied with their management and how this was negotiated, but some expressed surprise or dissatisfaction with lack of immediate treatment and questioned the need for referral to SSS. GPs welcomed the availability of SSS but some felt it important that they themselves also continued to support a quit attempt. Several saw advantages in offering NAT at the time the patient was motivated to stop.
CONCLUSIONS
Smokers appear less convinced than GPs about the value of referral to SSS, although these differences may be resolved through negotiation. An alternative strategy to that proposed by NICE, which may be more acceptable to some smokers, is immediate treatment with subsequent support from SSS.