动机性访谈对社区卫生服务中心吸烟患者戒烟效果的随机对照试验
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摘要
背景吸烟是多种慢性病的主要危险因素,动机性访谈(MI)应用于戒烟具有可靠的理论基础和易操作性。目的探讨MI对社区卫生服务中心吸烟患者的戒烟效果。方法选取北京市朝阳区八里庄社区卫生服务中心吸烟患者为研究对象。采用均衡随机化分组方式,采用分配隐匿的原则,将纳入的210例社区吸烟患者分配至对照组与干预组。研究对象纳入时间为2016年7—10月。对照组依据《中国临床戒烟指南(2015年版)》给予简短戒烟干预,干预组由全科医生给予MI戒烟干预。比较两组基线资料以及干预3个月和6个月时患者戒烟率、一氧化碳呼出检测等级和尼古丁依赖程度。结果对照组与干预组吸烟患者基线特征,包括性别、年龄、文化程度、婚姻状况、慢性病患病情况、烟龄、北京最严禁烟令知晓率、一氧化碳呼出检测等级、尼古丁依赖检测量表(FTND)得分比较,差异均无统计学意义(P>0.05)。意向处理(ITT)分析结果显示,干预3、6个月时,对照组和干预组一氧化碳呼出检测等级、FTND分值比较,差异均有统计学意义(P<0.05);对照组和干预组戒烟率比较,差异无统计学意义(P>0.05)。符合方案数据集(PPS)分析结果显示,干预3个月时,对照组和干预组FTND分值比较,差异有统计学意义(P<0.05);戒烟率、一氧化碳呼出检测等级比较,差异无统计学意义(P>0.05)。干预6个月时,对照组和干预组一氧化碳呼出检测等级、FTND分值比较,差异有统计学意义(P<0.05);戒烟率比较,差异无统计学意义(P>0.05)。结论与简短戒烟干预方式相比,尚未发现MI更能有效降低戒烟率,但MI可降低吸烟患者一氧化碳呼出检测等级和尼古丁依赖程度。
Background Smoking is a major risk factor for many chronic diseases. Motivational interviewing(MI)is a technique with solid theoretical basis and ease to operate.Objective To evaluate the effectiveness of MI for smoking cessation in community health service centers.Methods All subjects in this study were smoking patients from Balizhuang Community Health Service Center in Chaoyang District in Beijing. Blocked randomization was used.Totally 210 smoking patients were allocated into either intervention group or control group followed allocation concealment rules.All subjects were included from July 2016 to October 2016.We followed the Chinese Clinical Smoking Cessation Guideline(version 2015) to provide brief smoking cessation intervention in the control group. MI was used in the intervention group and was given by family physicians. The followup period was 3 and 6 month respectively. The outcomes include smoking prevalence abstinence,CO-oximetry value and nicotine dependency level.Results The baseline characteristics showed that there was no significant difference between the intervention group and control group with regard to gender,age,level of education,marriage,prevalence of chronic disease,years of smoking,knowledge of smoking ban in Beijing,CO-oximetry value and scores of Fagerstrom Test of Nicotine Dependence(FTND)(P>0.05). Results from intention to treat analyses(ITT) showed that compared with control group,CO-oximetry value and FTND scores decreased significantly in the intervention group at the 3 and 6 month follow-up respectively(P<0.05). Compared with control group,the 3 and 6 month smoking prevalence abstinence did not decreased significantly in the intervention group(P>0.05). Results from per protocol set(PPS) showed that compared with control group,FTND scores decreased significantly in the intervention group at the 3 month follow-up(P<0.05). Compared with control group,neither the smoking prevalence abstinence nor the CO-oximetry value decreased significantly in the intervention group at the 3 month follow-up(P>0.05). Compared with control group, CO-oximetry value and FTND scores decreased significantly in the intervention group at the 6 month follow-up(P<0.05). Compared with control group,the 6 month smoking prevalence abstinence did not decrease significantly in the intervention group(P>0.05).Conclusion Compared with brief smoking cessation intervention,MI is very likely to decrease the exhaled CO-oximetry value and nicotine dependence level for smokers,but may fail to decrease smoking cessation rate.
Background Smoking is a major risk factor for many chronic diseases. Motivational interviewing(MI)is a technique with solid theoretical basis and ease to operate.Objective To evaluate the effectiveness of MI for smoking cessation in community health service centers.Methods All subjects in this study were smoking patients from Balizhuang Community Health Service Center in Chaoyang District in Beijing. Blocked randomization was used.Totally 210 smoking patients were allocated into either intervention group or control group followed allocation concealment rules.All subjects were included from July 2016 to October 2016.We followed the Chinese Clinical Smoking Cessation Guideline(version 2015) to provide brief smoking cessation intervention in the control group. MI was used in the intervention group and was given by family physicians. The followup period was 3 and 6 month respectively. The outcomes include smoking prevalence abstinence,CO-oximetry value and nicotine dependency level.Results The baseline characteristics showed that there was no significant difference between the intervention group and control group with regard to gender,age,level of education,marriage,prevalence of chronic disease,years of smoking,knowledge of smoking ban in Beijing,CO-oximetry value and scores of Fagerstrom Test of Nicotine Dependence(FTND)(P>0.05). Results from intention to treat analyses(ITT) showed that compared with control group,CO-oximetry value and FTND scores decreased significantly in the intervention group at the 3 and 6 month follow-up respectively(P<0.05). Compared with control group,the 3 and 6 month smoking prevalence abstinence did not decreased significantly in the intervention group(P>0.05). Results from per protocol set(PPS) showed that compared with control group,FTND scores decreased significantly in the intervention group at the 3 month follow-up(P<0.05). Compared with control group,neither the smoking prevalence abstinence nor the CO-oximetry value decreased significantly in the intervention group at the 3 month follow-up(P>0.05). Compared with control group, CO-oximetry value and FTND scores decreased significantly in the intervention group at the 6 month follow-up(P<0.05). Compared with control group,the 6 month smoking prevalence abstinence did not decrease significantly in the intervention group(P>0.05).Conclusion Compared with brief smoking cessation intervention,MI is very likely to decrease the exhaled CO-oximetry value and nicotine dependence level for smokers,but may fail to decrease smoking cessation rate.
引文
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[6]刘建平.临床试验样本含量的计算[J].中国中西医结合杂志,2003,23(7):536-538.DOI:10.3321/j.issn:1003-5370.2003.07.017.LIU J P.Sample size calculation for clinical trial[J].Chinese Journal of Integrated Traditional and Western Medicine,2003,23(7):536-538.DOI:10.3321/j.issn:1003-5370.2003.07.017.
[7]黄亚芳,张振汉,赵亚利,等.动机性访谈戒烟技巧与示范[J].继续医学教育,2016,30(1):166-168.DOI:10.3969/j.issn.1004-6763.2016.01.104.HUANG Y F,ZHANG Z H,ZHAO Y L,et al.Motivational interviewing for smoking cessation technique and case report[J].Continuing Medical Education,2017,30(1):166-168.DOI:10.3969/j.issn.1004-6763.2016.01.104.
[8]罗子超.动机性访谈治疗方案对戒烟之效果研究:以澳门戒烟咨询门诊戒烟人士为例[D].澳门:澳门科技大学,2012.LUO Z C.The effectiveness of motivational interviewing in smoking cessation:an experimental study in smoking cessation and counseling clinic in Macau[D].Macau:Macau University of Science and Technology,2012.
[9]潘珏,金文婷,王晓丹,等.中文版尼古丁依赖检测量表信度和效度的初步研究[J].国际呼吸杂志,2010,30(5):266-269.DOI:10.3760/cma.j.issn.1673-436X.2010.05.004.PAN J,JIN W T,WANG X D,et al.Psychometric property of Chinese version of the Fagerstrom Test of Nicotine Dependence[J].International Journal of Respiration,2010,30(5):266-269.DOI:10.3760/cma.j.issn.1673-436X.2010.05.004.
[10]鲍云霞,文春艳,赵静,等.动机性访谈对促进慢性阻塞性肺病老年男性患者戒烟及生活质量改善的影响[J].中国医药导报,2014,11(36):100-103.BAO Y X,WEN C Y,ZHAO J,et al.Effects of motivational interviewing on smoking cessation and quality of life among old male patients with chronic obstructive pulmonary disease[J].China Medical Herald,2014,11(36):100-103.
[2]中华人民共和国国家卫生和计划生育委员会.中国临床戒烟指南(2015年版)[M].北京:人民卫生出版社,2015.
[3]MILLER R W,ROLLNICK S.Motivational interviewing:preparing people to change addictive behavior[M].New York:Guilford Press,1991.
[4]MILLER W R,ROSE G S.Motivational interviewing in relational context[J].American Psychologist,2010,65(4):298-299.DOI:10.1037/a0019487.
[5]LINDSON-HAWLEY N,THOMPSON T P,BEGH R.Motivational interviewing for smoking cessation[J].Cochrane Database of Systematic Reviews,2015,3(3):CD006936.DOI:10.1002/14651858.CD006936.pub3.
[6]刘建平.临床试验样本含量的计算[J].中国中西医结合杂志,2003,23(7):536-538.DOI:10.3321/j.issn:1003-5370.2003.07.017.LIU J P.Sample size calculation for clinical trial[J].Chinese Journal of Integrated Traditional and Western Medicine,2003,23(7):536-538.DOI:10.3321/j.issn:1003-5370.2003.07.017.
[7]黄亚芳,张振汉,赵亚利,等.动机性访谈戒烟技巧与示范[J].继续医学教育,2016,30(1):166-168.DOI:10.3969/j.issn.1004-6763.2016.01.104.HUANG Y F,ZHANG Z H,ZHAO Y L,et al.Motivational interviewing for smoking cessation technique and case report[J].Continuing Medical Education,2017,30(1):166-168.DOI:10.3969/j.issn.1004-6763.2016.01.104.
[8]罗子超.动机性访谈治疗方案对戒烟之效果研究:以澳门戒烟咨询门诊戒烟人士为例[D].澳门:澳门科技大学,2012.LUO Z C.The effectiveness of motivational interviewing in smoking cessation:an experimental study in smoking cessation and counseling clinic in Macau[D].Macau:Macau University of Science and Technology,2012.
[9]潘珏,金文婷,王晓丹,等.中文版尼古丁依赖检测量表信度和效度的初步研究[J].国际呼吸杂志,2010,30(5):266-269.DOI:10.3760/cma.j.issn.1673-436X.2010.05.004.PAN J,JIN W T,WANG X D,et al.Psychometric property of Chinese version of the Fagerstrom Test of Nicotine Dependence[J].International Journal of Respiration,2010,30(5):266-269.DOI:10.3760/cma.j.issn.1673-436X.2010.05.004.
[10]鲍云霞,文春艳,赵静,等.动机性访谈对促进慢性阻塞性肺病老年男性患者戒烟及生活质量改善的影响[J].中国医药导报,2014,11(36):100-103.BAO Y X,WEN C Y,ZHAO J,et al.Effects of motivational interviewing on smoking cessation and quality of life among old male patients with chronic obstructive pulmonary disease[J].China Medical Herald,2014,11(36):100-103.