Smoking cessation guidelines for health professionals: an update
Smoking cessation guidelines for health professionals: an update
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DOI：
10.1136/thorax.55.12.987
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发表时间：
2000-12-01
期刊：
影响因子：
10
通讯作者：
Raw, M
中科院分区：
文献类型：
--
作者：
West, R;McNeill, A;Raw, M
本文更新了1998年发表在Thorax杂志上的健康教育机构(HEA)针对健康专业人员的戒烟指南的证据基础和主要建议。更新证据基础的战略利用了最新的Cochrane审查，并酌情辅之以个别研究。这一最新情况载有关于干预措施有效性的更多细节以及对与执行有关的问题的评论。这些建议包括澄清一些重要的问题，这些问题在最初的准则中只是笼统地处理。通过国家卫生服务提供的戒烟干预是维持生命和减少不良健康的极具成本效益的方式，这一结论没有改变。指南建议的策略包括：(1)全科医生在例行咨询期间机会性地建议吸烟者戒烟，就帮助他们的有效药物提供建议和/或开出有效的药物，并将他们转介至戒烟专科服务；(2)吸烟者专科服务，(以团体或个人形式)为希望在戒烟和尽可能使用有效药物方面获得帮助的吸烟者提供行为支持；(3)专业戒烟咨询师，为住院患者和怀孕吸烟者提供行为支持，帮助他们戒烟；(4)鼓励和协助吸烟者使用尼古丁替代疗法(NRT)或安非他酮(视情况而定)。对先前指南的澄清要点包括：(1)初级卫生保健团队和医院应创建并保存关于患者当前吸烟状况的易于获取的记录；(2)全科医生应致力于建议吸烟者戒烟，并至少每年一次这样做的记录；(3)应建议住院、门诊和怀孕吸烟者尽早戒烟，并以易于获取的形式将建议记录在笔记中；(4)目前几乎没有科学依据将个人吸烟者与特定形式的NRT相匹配；(5)NHS吸烟者专科诊所应该是吸烟者需要帮助的第一个转介点，而不是通过全科医生的简单建议来提供帮助；(6)对于没有专科诊所的吸烟者，应该提供训练有素的戒烟专业人员的帮助，例如实习护士；(7)NHS吸烟者专科诊所的提供应该与需求相称；这目前是一到两个全职诊所或相当于平均规模的卫生当局，但随着围绕服务的宣传的增加，需求可能会上升。
This paper updates the evidence base and key recommendations of the Health Education Authority (HEA) smoking cessation guidelines for health professionals published in Thorax in 1998. The strategy for updating the evidence base makes use of updated Cochrane reviews supplemented by individual studies where appropriate. This update contains additional detail concerning the effectiveness of interventions as well as comments on issues relating to implementation. The recommendations include clarification of some important issues addressed only in general terms in the original guidelines. The conclusion that smoking cessation interventions delivered through the National Health Service are an extremely cost effective way of preserving life and reducing ill health remains unchanged. The strategy recommended by the guidelines involves: (1) GPs opportunistically advising smokers to stop during routine consultations, giving advice on and/or prescribing effective medications to help them and referring them to specialist cessation services; (2) specialist smokers' services providing behavioural support (in groups or individually) for smokers who want help with stopping and using effective medications wherever possible; (3) specialist cessation counsellors providing behavioural support for hospital patients and pregnant smokers who want help with stopping; (4) all health professionals involved in smoking cessation encouraging and assisting smokers in use of nicotine replacement therapies (NRT) or bupropion where appropriate. The key points of clarification of the previous guidelines include: (1) primary health care teams and hospitals should create and maintain readily accessible records on the current smoking status of patients; (2) GPs should aim to advise smokers to stop, and record having done so, at least once a year; (3) inpatient, outpatient, and pregnant smokers should be advised to stop as early as possible and the advice recorded in the notes in a readily accessible form; (4) there is currently little scientific basis for matching individual smokers to particular forms of NRT; (5) NHS specialist smokers' clinics should be the first point of referral for smokers wanting help beyond what can be provided through brief advice from the GP; (6) help from trained health care professionals specialising in smoking cessation such as practice nurses should be available for smokers who do not have access to specialist clinics; (7) the provision of specialist NHS smokers' clinics should be commensurate with demand; this is currently one or two full time clinics or their equivalent per average sized health authority, but demand may rise as publicity surrounding the services increases.