HOSPITAL-BASED NURSE-MANAGED SMOKING INTERVENTIONS

每年大约有1000万美国吸烟者住院。 医院禁烟促进住院患者短期戒烟 患者，但长期戒烟需要预防复发 策略。拟议的项目比较了两家医院的疗效- 以护士为基础的戒烟管理干预。吸烟者 住进旧金山湾的两家大型凯撒基金会医院 对标准化问卷的回答反映为中等程度的地区 到很高的戒烟意向，并且到期的CO值小于 注册后48-72小时10ppm将随机分配到：GP1，通常 CARE(n-1200)，GP2，最少随访的干预(n-400)，或GP3， 强化随访的干预措施(n-400)。项目护士在- 对第2组和第3组患者的医院咨询增加了一个 录像带和自助材料。GP2中的住院后随访是 在1周和GP3中通过RN发起的单一电话联系 12周内复发的患者将额外接受一次咨询 以及多达2个额外的后续电话联系人。主要结果是， 在1岁时测量，是否通过唾液确认戒烟率 可替宁测量。功率计算以停机1年为基础 第1、2、3组分别为15%、20%、30%， 分别进行了分析。花费约42美元，预计将停止 30%的比率GP3干预具有估计的成本效益 比率为280美元/点，而GP2干预组为480美元/点， 价格约为24美元，预计停机率为20%。瞄准 针对特定患者亚群需求的干预措施可能是 通过对人口统计、医疗和吸烟的多变量分析提供便利 变量。促进传播的研究的最终产品 包括1)有效护士培训计划，2)有效 为患者提供的教学材料和易于使用的计算机 提高干预效果和效率的软件。

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.