NURSE-ASSISTED COUNSELING FOR SMOKERS IN PRIMARY CARE
NURSE-ASSISTED COUNSELING FOR SMOKERS IN PRIMARY CARE
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DOI：
10.7326/0003-4819-118-7-199304010-00006
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发表时间：
1993-04-01
影响因子：
39.2
通讯作者：
BIGLAN, A
中科院分区：
文献类型：
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作者：
HOLLIS, JF;LICHTENSTEIN, E;BIGLAN, A
目的：医生提供的戒烟建议是有效的，但时间要求往往会减少接受帮助的吸烟者的数量。我们评估了三种护士辅助的干预措施，旨在减少医生的负担并增加初级保健环境中的咨询。设计：随机对照试验，为期12个月。地点：一家健康维护组织的内科和家庭诊所。参与者：吸烟者(n=3161)，他们是参与医生或其他医疗保健提供者的患者(n=60)。干预：医疗保健提供者向2707名吸烟者提供30秒的戒烟提示，并将他们转介给现场护士吸烟辅导员。护士随机提供一本两页的小册子(建议对照)或三种护士辅助干预措施之一：1)自我戒烟培训；2)转诊到团体戒烟计划；或3)自我戒烟培训和转介的组合。每个护士提供的干预包括10分钟的视频、书面材料和跟踪电话。结果：在为期一年的计划中，医生向86%的已识别吸烟者提供了简短的建议。在3个月和12个月的随访后，报告戒酒的参与者的比例在护士辅助的自我戒烟(7.1%)、团体转介(7.6%)和联合干预(6.9%)中几乎翻了一番(P=0.01)，而仅有简单的医生建议(3.9%)(P<；0.05)。唾液可替宁测试证实了这些影响(P<；0.004)，尽管戒烟率较低(分别为3.4%、4.7%、4.3%和2.3%)，因为大约一半的戒烟者选择不提供唾液样本，并被算作吸烟者。结论：与简单的医生建议相比，让护士参与咨询吸烟者减少了医生的负担，使咨询更有可能，并显著提高了戒烟率。
Objective: Physician-delivered advice to stop smoking is effective, but time demands often reduce the number of smokers who receive assistance. We evaluated three nurse-assisted interventions designed to minimize physician burden and increase counseling in primary care settings.Design: Randomized controlled trial with a 12-month follow-up.Setting: Internal medicine and family practice offices in a health maintenance organization.Participants: Smokers (n = 3161) who were patients of participating physicians or other medical care providers (n = 60).Intervention: Medical care providers delivered a 30-second stop-smoking prompt to 2707 smokers and referred them to an on-site nurse smoking counselor. The nurse randomly provided a two-page pamphlet (advice control) or one of three nurse-assisted interventions: 1) self-quit training; 2) referral to a group cessation program; or 3) a combination of self-quit training and referral. Each nurse-delivered intervention included a 10-minute video, written materials, and a follow-up phone call.Results: Physicians delivered brief advice to 86% of identified smokers during the 1-year program. The proportion of participants reporting abstinence after both 3 and 12 months of follow-up nearly doubled (P = 0.01) for the nurse-assisted self-quit (7.1%), group-referral 7.6%), and combination (6.9%) interventions, compared to brief physician advice alone (3.9%) (P < 0.05). Saliva cotinine tests confirmed these effects (P < 0.004), although quit rates were lower (3.4%, 4.7%, 4.3%, and 2.3%, respectively) because roughly one half of quitters chose not to provide a saliva sample and were counted as smokers.Conclusion: Involving nurses in counseling smokers reduces physician burden, makes counseling more likely, and significantly increases cessation rates compared with brief physician advice alone.