HOSPITAL-BASED NURSE-MANAGED SMOKING INTERVENTIONS

每年大约有1000万美国吸烟者住院。 医院禁烟有助于住院病人短期戒烟 患者，但长期戒烟需要预防复发 战略 该项目比较了两家医院的疗效- 基于护士管理的戒烟干预措施。 吸烟者 在旧金山弗朗西斯科湾的两家大型凯撒基金会医院接受治疗 对标准化调查表的答复反映出中等 戒烟意愿高，过期CO值小于 入组后48-72小时10 ppm将随机分配至：GP 1，常规 护理（n-1200）、GP 2、最低限度随访的干预（n-400）或GP 3， 强化随访干预（n-400）。 项目护士在- 第2组和第3组患者的医院咨询得到了加强， 录像带和自助材料。 GP 2的出院后随访是 在第1周和第3周通过RN发起的一次电话联系 12周内复发的患者接受1次额外的咨询访视 以及最多2个后续电话联系人。 主要结果， 在1年时测量，是否通过唾液检查证实了戒烟率 可替宁测量。 功效计算基于1年停用 第1、2和3组患者的发生率分别为15%、20%和30%， 分别 费用约为42美元， GP 3干预的估计成本效益为30% 比率为280美元/患者，而GP 2干预为480美元/患者， 费用约为24美元，预期戒烟率为20%。 靶向 针对特定亚组患者需求的干预措施可能是 通过人口统计学、医疗和吸烟的多变量分析， 变量 促进传播的研究最终产品 包括1）有效护士培训计划，2）有效的 为病人提供的指导材料和3）用户友好的计算机 提高干预措施的效力和效率的软件。

Approximately 10 million American smokers are hospitalized each year. Hospital smoking bans facilitate short term abstinence for hospitalized patients, but long-term cessation requires a relapse prevention strategy. The proposed project compares the efficacy of 2 hospital- based nurse-managed interventions for smoking cessation. Smokers admitted to 2 large Kaiser-Foundation hospitals in the San Francisco Bay Area whose responses to a standardized questionnaire reflect a moderate to high intention to quit and whose values of expired CO are less than 10ppm 48-72 hours after enrollment will be randomized to: GP1, usual care (n-1200), GP2, intervention with minimal followup (n-400), or GP3, intervention with intensive followup (n-400). Project nurses' in- hospital counseling of patients in groups 2 and 3 is augmented by a videotape and self help materials. Post -hospital followup in GP2 is through a single RN-initiated telephone contact at 1 week and in GP3 patients who relapse by 12 week receive 1 additional counseling visit and up to 2 additional followup phone contacts. The primary outcome, measured at 1 year, is smoking cessation rate confirmed by salivary cotinine measurements. Power calculations are based on 1 year cessation rates of 15%, 20% and 30% in patients of Groups 1, 2 and 3, respectively. At a cost of approximately $42 and an expected cessation rate of 30% the GP3 intervention has an estimated cost effectiveness ratio of $280/pt, compared to $480/pt for the GP2 intervention, which costs about $24 and has an expected cessation rate of 20%. Targeting the interventions to the needs of specific subgroups of patients may be facilitated by multivariate analysis of demographic, medical and smoking variables. End-products of the research that facilitate dissemination include 1) an efficient training program for nurses, 2) effective instructional materials for patients and 3) user-friendly computer software that enhances the efficacy and efficiency of the interventions.