执业医师的戒烟模式：对强化的常规戒烟支持进行的一项整群随机试验
2011/01/27
摘要
背景：本实验研究了为满足多数患者需求所设计的、由执业护士（PN）提供的一系列灵活的戒烟支持在戒烟中的使用率和有效性。
方法：本研究为整群随机试验，处理措施分配于如下3组：（1）由执业护士帮助戒烟；（2）戒烟热线帮助戒烟；（3）GP常规治疗组。PN在进入干预组之前需接受戒烟培训课程，然后对戒烟者进行指导。戒烟热线干预组的GP清楚本项研究的信息并了解书面转诊的过程。常规治疗组的GPs应该了解研究相关信息。入选患者为每天或每周吸烟，并且能签署知情同意书的18岁以上吸烟者。在三组患者中，对于低收入患者，免费给予尼古丁贴剂。主要结果为3个月和12个月时的持续戒断率和点戒断率以及12个月时增量成本效益比。患者通过计算机辅助的电话访谈（CATI）与PN和GP进行半结构式访谈，收集关于戒断支持可及性以及干预措施的可接受性的数据。主要分析采用意向治疗分析。采用多元logistic回归分析3个月和12个月时三组患者的戒断转归。相对于常规治疗组，估计干预组12个月戒断率的增量成本效益比。有关戒断效果的分类数据基于主题分析法进行分析。
讨论：需要有关执业护士干预有效性的高质量证据来制定健康政策，以培养和提升执业护士的地位。如果有效，执业护士与GP联合的灵活性支持及戒烟热线可能成为澳大利亚戒烟的一个首选模式。
（林江涛 审校）
BMC Fam Pract. 2010 Aug 12;11(1):59. [Epub ahead of print]
Quit in General Practice: a cluster randomised trial of enhanced in-practice support for smoking cessation.
Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, Blackberry I, Borland R.
Abstract
BACKGROUND: This study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients.
METHODS: This study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study and the process of written referral and GPs in the usual care group will receive information about the study. Eligible patients are those aged 18 and over presenting to their GP who are daily or weekly smokers and who are able to give informed consent. Patients on low incomes in all three groups will be able to access free nicotine patches. Primary outcomes are sustained abstinence and point prevalence abstinence at the three month and 12 month follow-up points; and incremental cost effectiveness ratios at 12 months. Process evaluation on the reach and acceptability of the intervention approached will be collected through Computer Assisted Telephone Interviews (CATI) with patients and semi-structured interviews with PNs and GPs. The primary analysis will be by intention to treat. Cessation outcomes will be compared between the three arms at three months and 12 month follow-up using multiple logistic regression. The incremental cost effectiveness ratios will be estimated for the 12 month quit rate for the intervention groups compared to usual care and to each other. Analysis of qualitative data on process outcomes will be based on thematic analysis.
DISCUSSION: High quality evidence on effectiveness of practice nurse interventions is needed to inform health policy on development of practice nurse roles. If effective, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice. Trial Registration: ACTRN12609001040257.
上一篇：
为什么经济上的刺激不能有效影响吸烟者戒烟？来自评价经济刺激在戒烟中作用的“现场试验过程评价”结果
下一篇：
住院患者戒烟计划的有效性研究
