初级临床护理机构采用包括戒烟建议和肺量计信息的动机干预措施的戒烟效果:ESPITAP研究
2011/12/26
摘要
背景:目前,有关基于肺活量信息的干预措施的戒烟疗效存在争议。本试验旨在初级护理机构中,与常规临床实践相比,结构化动机干预措施的戒烟疗效。
方法/设计:本研究为多中心随机临床试验,包括干预组和对照组。参与机构:西班牙塔拉戈纳省的12个初级护理中心。研究对象:600名35~70岁的当前吸烟者入选。受试者每年累计吸烟超过10包,因各种原因而至初级护理机构就诊,不满足本研究的排除标准,随机分为结构性干预措施和标准临床干预措施组。
干预措施:由全科医师提供常规戒烟建议,同时对受试者进行20 min的个性化随访,提供肺量计相关信息,期间与受试者讨论FEV1、FVC、FEF 25~75%和PEF及其标准值。其他信息包括肺年龄指数(相同FEV1的非吸烟者平均年龄),比较肺年龄指数与实足年龄来研究吸烟导致的肺功能恶化。检测指标:初始随访时的肺活量。在初级护理中心,初次随访和12个月随访时,进行结构化访谈问卷调查。6个月时进行电话随访。12个月随访时,检测主诉戒烟的吸烟者呼出气CO。主要变量:12个月时的戒烟。
分析:基于意向治疗进行数据分析,对个体吸烟者进行分析。期望结果:初级护理机构的主动吸烟者,我们期望干预组的戒断要显著高于对照组。
讨论:基于有关肺量计结果的信息的动机干预,能改善实际初级护理机构吸烟者的戒断率。临床试验注册号:NCT01194596。
(林江涛 审校)
BMC Public Health. 2011 Nov 11;11(1):859. [Epub ahead of print]
Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: The ESPITAP study.
Martin-Lujan F, Pinol-Moreso JL, Martin-Vergara N, Basora-Gallisa J, Pascual-Palacios I, Sagarra-Alamo R, Aparicio-Llopis E, Basora-Gallisa T, Pedret-Llaberia R, Study Group E.
Abstract
BACKGROUND: There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice.
METHODS/ DESIGN: Multicentre randomized clinical trial with an intervention and a control group. Setting: 12 primary care centres in the province of Tarragona (Spain). Subjects of study: 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. INTERVENTION: Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant), comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. Measurements: Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. Main variables: Smoking cessation at 12 months.
ANALYSIS: Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. Expected results: Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the intervention group than in the control group.
DISCUSSION: Application of a motivational intervention based on structured information about spirometry results, improved abstinence rates among smokers seen in actual clinical practice conditions in primary care. Trial registration ClinicalTrial.gov, number NCT01194596.
BMC Public Health. 2011 Nov 11;11(1):859. [Epub ahead of print]
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初级临床护理机构采用包括戒烟建议和肺量计信息的动机干预措施的戒烟效果:ESPITAP研究
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患肺和头颈部恶性肿瘤的吸烟者和近期戒烟者中与戒烟相关的因素