办公室启动多层次控烟干预：一项随机研究
2018/01/15
摘要
背景：针对儿童烟草暴露（TSE）的最佳实践指南（询问、建议和参考[AAR]）依从性可以鼓励家长降低TSE。然而，高风险、易感吸烟者需要更高强度的治疗。我们臆想务实、多层次治疗模式包括AAR联合个体化、电话咨询促进儿童TSE降低可以较标准AAR更好提高儿童TSE。
方法：在双臂随机对照研究中，我们培训低收入区域儿科医务人员通过常规健康记录评估做出快速辅助决策从而改善AAR。医务人员将情况传真并接受进一步AAR依从性反馈。经查受试者可以入选如满足每日吸烟者，>17岁，可以说英语。受试者经随机分配进入电话咨询组（AAR和咨询）或营养教育（AAR和注意力控制）。受试者完成随机前和3个月的随访评估。
结果：在所有医务人员中，>80%(n=334)循序AAR，并传真2949份内容。受试者（n=327）中83%为女性，83%非洲裔美国人，79%为低收入人群（低于贫困线）。意向性治疗回归分析提示强有力的阳性治疗结果：较AAR联合注意力控制，AAR联合咨询组中更多家长清除所有来源TSE(45.8% vs 29.9%; OR=1.99; 95%CI: 1.44～2.74)以及戒烟成功(28.2% vs 8.2%; OR=3.78; 95%CI: 1.51～9.52)。
结论：研究结果提示相比较单独AAR干预，将临床和个人戒烟干预整合可以改善TSE和戒烟成果。此外，本研究第一次将AAR决策融入电子病历，从而将TSE干预措施融入到日常临床实践中。
An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial.
Pediatrics. 2018 Jan;141(Suppl 1): S75-S86. doi: 10.1542/peds.2017-1026K.
Collins BN, Lepore SJ, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Davey A, Taylor D, Fleece D, Godfrey M.
Abstract
BACKGROUND:Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR.
METHODS:In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, >17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments.
RESULTS:Of providers, >80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44-2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51-9.52]).
CONCLUSIONS:The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
背景：针对儿童烟草暴露（TSE）的最佳实践指南（询问、建议和参考[AAR]）依从性可以鼓励家长降低TSE。然而，高风险、易感吸烟者需要更高强度的治疗。我们臆想务实、多层次治疗模式包括AAR联合个体化、电话咨询促进儿童TSE降低可以较标准AAR更好提高儿童TSE。
方法：在双臂随机对照研究中，我们培训低收入区域儿科医务人员通过常规健康记录评估做出快速辅助决策从而改善AAR。医务人员将情况传真并接受进一步AAR依从性反馈。经查受试者可以入选如满足每日吸烟者，>17岁，可以说英语。受试者经随机分配进入电话咨询组（AAR和咨询）或营养教育（AAR和注意力控制）。受试者完成随机前和3个月的随访评估。
结果：在所有医务人员中，>80%(n=334)循序AAR，并传真2949份内容。受试者（n=327）中83%为女性，83%非洲裔美国人，79%为低收入人群（低于贫困线）。意向性治疗回归分析提示强有力的阳性治疗结果：较AAR联合注意力控制，AAR联合咨询组中更多家长清除所有来源TSE(45.8% vs 29.9%; OR=1.99; 95%CI: 1.44～2.74)以及戒烟成功(28.2% vs 8.2%; OR=3.78; 95%CI: 1.51～9.52)。
结论：研究结果提示相比较单独AAR干预，将临床和个人戒烟干预整合可以改善TSE和戒烟成果。此外，本研究第一次将AAR决策融入电子病历，从而将TSE干预措施融入到日常临床实践中。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Pediatrics. 2018 Jan;141(Suppl 1): S75-S86. doi: 10.1542/peds.2017-1026K.）
（Pediatrics. 2018 Jan;141(Suppl 1): S75-S86. doi: 10.1542/peds.2017-1026K.）
An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial.
Pediatrics. 2018 Jan;141(Suppl 1): S75-S86. doi: 10.1542/peds.2017-1026K.
Collins BN, Lepore SJ, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Davey A, Taylor D, Fleece D, Godfrey M.
Abstract
BACKGROUND:Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR.
METHODS:In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, >17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments.
RESULTS:Of providers, >80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44-2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51-9.52]).
CONCLUSIONS:The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
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父母戒烟：对于家庭儿童烟草暴露的影响
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中国医院儿科实施控烟辅助措施：一项可行性研究
