Factors influencing implementation of smoking cessation treatment within community mental health centers.
Factors influencing implementation of smoking cessation treatment within community mental health centers.
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DOI：
10.1080/15504263.2015.1025025
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发表时间：
2015
影响因子：
2.2
通讯作者：
Dixon LB
中科院分区：
文献类型：
--
作者：
Brown CH;Medoff D;Dickerson FB;Fang LJ;Lucksted A;Goldberg RW;Kreyenbuhl J;Himelhoch S;Dixon LB
患有严重精神疾病的消费者吸烟较多，患吸烟相关疾病的风险也较高。我们在大巴尔的摩的六个社区心理健康中心研究了影响实施“5A”（询问、建议、评估、协助、安排）的提供者和消费者因素。收集的数据是一项大型研究的一部分，该研究旨在检查患者就诊时提供 5A 的有效性。首先，我们检查了对 49 名临床医生进行的一项关于实现 5A 的障碍和态度的调查的答复。其次，我们使用多水平模型来检查患者 (n=228) 之间的差异、患者因素以及精神科医生 (n=28) 之间在 5A（以及前 3A）实施中的差异。最强烈认可的障碍是患者对戒烟缺乏兴趣。精神科医生和患者在 5A 和 3A 的实施中均存在显着差异。患者的“改变准备程度”预测了完整的 5A 的实现，而吸烟严重程度则预测了前 3A 的实现。迫切需要创造性和协作性的解决方案、政策和临床医生培训，以解决在精神卫生保健环境中提供循证戒烟治疗的实际和感知障碍。
Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidenced based “5A’s” (Ask, Advise, Assess, Assist, Arrange) in six community mental health centers in greater Baltimore. Data collected as part of a larger study examining the effectiveness of delivery of the 5A’s at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5A’s. Second, we used multilevel models to examine variance between patients (n=228), patient factors, and variance between their psychiatrists (n=28) in the delivery of the 5A’s (and first 3 A’s). The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5A’s and 3A’s. Patient “readiness to change” predicted delivery of the full 5A’s, while smoking severity predicted delivery of the first 3 A’s. There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidenced-based smoking cessation treatment in the mental health care setting.