Tailored tobacco dependence support for mental health patients: a model for inpatient and community services
Tailored tobacco dependence support for mental health patients: a model for inpatient and community services
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DOI：
10.1111/j.1360-0443.2012.04082.x
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发表时间：
2012-12-01
期刊：
影响因子：
6
通讯作者：
Ratschen, Elena
中科院分区：
文献类型：
--
作者：
Parker, Camilla;McNeill, Ann;Ratschen, Elena
虽然严重精神疾病患者的吸烟率很高，但这个问题在很大程度上仍未得到解决。这一务实的试点项目旨在在精神健康环境中制定和实施量身定制的烟草依赖服务，并评估其影响以及实施的障碍和促进因素。设计一种综合服务模式，涵盖急性、康复和社区服务，包括设计量身定制的工具和转诊途径，由两名精神卫生专业人员提供。环境和参与者英国最大的精神健康信托基金的四个成人急性病房和两个康复病房（129张床位）以及社区康复小组（2038例）。对病历中吸烟信息的审计服务吸收;戒烟的尝试;戒烟和减少吸烟；关于实施障碍/促进因素的定性数据。结果：共有110名患者参加了至少一次支持会议：53名住院患者（占住院吸烟者的23%）和57名社区吸烟者（未知数量的社区吸烟者，因为吸烟状况记录不是强制性的）。其中34人（31%）曾尝试戒烟；17人（15%）停止吸烟，29人（26%）在最后接触时减少了高达50%的卷烟消费量。实施服务的障碍涉及：（一）信任政策、制度和程序；（二）工作人员的知识和态度；（三）与疾病有关的因素。尽管联合王国有强烈的反吸烟氛围，包括一项要求在精神卫生机构实行无烟政策的法律，但由于复杂的系统性障碍，为精神疾病患者建立戒烟治疗服务被证明是困难的。然而，患者显然对这种服务有需求。
Aims Although smoking prevalence among people with severe mental illness is high, it remains largely unaddressed. This pragmatic pilot project aimed to develop and implement a tailored tobacco dependence service in mental health settings and to assess its impact, as well as barriers and facilitators to implementation. Design An integrative service model, spanning acute, rehabilitation and community services, including the design of tailored instruments and referral pathways, delivered by two mental health professionals. Setting and participants Four adult acute and two rehabilitation wards (129 beds), and the community recovery team (2038 cases) of the United Kingdom's largest Mental Health Trust. Measurements Audit of smoking information in patient notes; service uptake; quit attempts; smoking cessation and reduction; qualitative data on implementation barriers/facilitators. Findings A total of 110 patients attended at least one support session: 53 inpatients (23% of inpatient smokers) and 57 community (of unknown number of community smokers, as recording of smoking status is not mandatory). Thirty-four of these (31%) made a quit attempt; 17 (15%) stopped smoking and 29 (26%) reduced cigarette consumption by up to 50% at the final contact. Barriers to service implementation related to: (i) trust policy, systems and procedures, (ii) staff knowledge and attitudes and (iii) illness-related factors. Conclusions Despite the strong anti-smoking climate in the United Kingdom, including a law requiring smoke-free policies in mental health settings, establishing a smoking cessation treatment service for people with mental illness proved difficult, due to complex systemic barriers. However, there is clearly a demand, by patients, for such a service.