住院患者戒烟计划的有效性研究
2011/01/27
摘要
背景：住院患者戒烟可能增加出院后戒烟的成功率。
方法：采用准实验研究设计，对所使用的戒烟方法、死亡率、自我主诉的戒断和出院后6个月的戒断状态进行检测，评价住院患者戒烟计划的有效性。研究对象出院后6个月利用电话进行访谈。比较进行过住院戒烟咨询的患者的转归和未进行咨询患者的转归。电子病历（EMRs）和管理数据用于记录基线状态的检测指标、共患疾病、住院期间药物使用率、再入院、死亡等。多变量法包括logistic回归和生存分析。
结果：在基线状态下，各组平均年龄、住院天数（LOS）、共患病指数、心血管病诊断以及视敏度存在差异。出院后6个月，意向治疗估计的点戒断率，在干预组为16％，而在对照组为10％（P＝0.02）。而自我主诉的戒断状态比例在干预组和对照组分别为44%和30%（P=0.00）。与对照组相比，干预组在住院期间和出院后都采用更多的尼古丁替代治疗（NRT）。出院后的总体死亡率干预组显著低于对照组（分别为0.02和0.04）。多变量生存模型显示，对基线时的不平衡因素进行控制后，干预组死亡率显著下降（HR= 0.37; P = 0.04）。
结论：住院患者戒烟计划能有效改善戒烟转归、NRT使用和出院后的死亡率。
（陈欣 审校）
J Hosp Med. 2010 Aug 17. [Epub ahead of print]
Effectiveness of an inpatient smoking cessation program.
Gadomski AM, Gavett J, Krupa N, Tallman N, Jenkins P.
Bassett Research Institute, Cooperstown, New York.
Abstract
BACKGROUND: Inpatient smoking cessation may increase the success of quitting smoking post-hospital discharge.
METHODS: Using a quasiexperimental study design, use of cessation methods, mortality, self-reported abstinence, and quit status 6 months post-hospital discharge were measured to assess the effectiveness of an inpatient smoking cessation program. Subjects were interviewed by telephone 6 months post-hospital discharge. Outcomes for patients who were seen by the inpatient smoking cessation counselor were compared to consecutive patients who were not seen by the counselor. Electronic medical records (EMRs) and administrative data were used to construct baseline measures, comorbidity covariates, pharmaceutical use rates during hospitalization, readmission, and mortality outcomes. Multivariate methods included logistic regression and survival analysis.
RESULTS: At baseline, the study groups varied by mean age, length of stay (LOS), comorbidity index, cardiovascular diagnosis, and acuity. At 6 months post-hospital discharge, the intent to treat estimate for point prevalence abstinence was 16% in the intervention group compared to 10% in the comparison group (P = 0.02) while self-reported quit status in the intervention group was 44% vs. 30% in the comparison group (P = 0.00). The intervention group used more nicotine replacement therapy (NRT) than the comparison group both in-hospital and following discharge. Crude post-hospital discharge mortality was significantly less in the intervention group (0.02) than in the comparison group (0.04). A multivariate survival model, controlling for baseline imbalances, showed a significantly reduced mortality in the intervention group (hazard ratio [HR] = 0.37; P = 0.04).
CONCLUSIONS: Inpatient smoking cessation programs effectively improve quit outcomes, NRT use, and mortality post-hospital discharge.
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在俄罗斯癌症患者中，持续吸烟和戒烟动机的关系
