Utilization of the "Smokescreen" smoking-cessation programme by general practitioners and their patients

General practitioners have been encouraged to be more active in helping their patients to stop smoking. A number of research studies overseas and in Australia has reported that they can be effective in this form of health promotion. The "Smokescreen" programme is an intensive, structured antismoking intervention that was developed for use by general practitioners in Australia. To monitor the effect of this programme, general practitioners who had attended workshops on the use of the programme were contacted 12 months later to find out what use they had made of the programme, and how effective it had been. Only 18 of the 38 doctors who initially agreed to cooperate in the study had recruited smokers to the programme and had kept records of their progress. These 18 doctors had recruited 121 smokers in the 12-month period: only 7% (approximately) of all their patients who smoked. Of these, 29 (24%) patients reported that they had stopped smoking. Reasons that were given by doctors for their inability to use the programme as fully as they had hoped included the difficulty in recruiting smokers, a lack of time, and a low rate of return by the patients for follow-up visits. These results suggest that while general practitioners should be encouraged to give brief antismoking advice, general practice may not be a suitable location for more-intensive antismoking programmes. Limited health-promotional funds may be deployed better in general community awareness and mass-media programmes.     

Controlled trial of three different antismoking interventions in general practice

Of 6052 adult patients who consulted their doctors in six Oxfordshire general practices between October 1980 and February 1981, 2110 (35%) were smokers. The smokers were allocated to one of four study groups--a control (non-intervention) group; a group that received verbal and written antismoking advice from the general practitioner; a group that received this advice and also a demonstration of exhaled carbon monoxide; and a group that received the advice plus the offer of further help from a health visitor. After one year 72% of smokers replied to a postal follow up questionnaire: 11% of the control group claimed to have stopped smoking compared with 15% in the group that received advice alone, 17% in the exhaled carbon monoxide group, and 13% in the health visitor group. Validation of these findings by assays of urinary concentrations of cotinine showed that between 24% and 40% of subjects may have misreported their smoking habits, but there was no indication that the rate of misreporting was higher in the intervention groups than in the control group. Giving advice routinely against smoking has a useful effect, and showing an immediate, personal, and potentially harmful consequence of smoking using a CO-oximeter may improve this, particularly in lower socioeconomic groups.     

Three year evaluation of a programme by general practitioners to help patients to stop smoking

A controlled study was undertaken to measure the effectiveness of general practitioners' use of an intensive programme to help patients to stop smoking. Two hundred cigarette smokers who attended a general practice were allocated to either a treatment (n = 100) or a non-intervention control (n = 100) group. After the initial visit treatment consisted of an educational consultation and four follow up visits. Smoking state was assessed biochemically at six months and three years. Thirty five patients in the treatment group were abstinent at three years compared with eight in the control group (p less than 0.001). Sixty four patients attended the educational consultation and first follow up visit; of these, 45 were not smoking at the first follow up visit, 30 maintained abstinence up to six months, and 22 were still not smoking after three years. Among the 37 patients who completed the treatment programme and attended all the follow up visits 57% were abstinent at three years. The results of this study suggest that general practitioners can help patients to stop smoking.     

成都市医务人员吸烟状况及控烟干预研究

目的 了解成都市医务人员的吸烟状况及其控烟态度和行为,并对其进行干预及其效果评价。方法 采用问卷形式对成都市3家医院的932名医务人员的吸烟危害知识、控烟态度和行为进行调查,并对一家医院进行干预,同时对干预结果进行评价。结果 男性吸烟率为49．7％,女性为0．2％,男性吸烟者主要集中在外科医生和医技人员中;知识方面,对吸烟与肺癌、缺血性心脏病的关系掌握较好,但对被动吸烟与儿童中耳炎和猝死综合症关系回答正确的仅41．5％和48．2％;86．2％的不吸烟者中反对“被动吸烟无害”,但吸烟者中仅为70．4％,两者的差异有统计学意义;态度方面,对于以经济手段来处罚违反吸烟规定者,不吸烟者和吸烟者赞成的比例分别是87．5％和68．1％,差异有统计学意义（P＜0．001）;行为方面,不吸烟者询问病人吸烟状况的比例高于吸烟者,同时不吸烟者鼓励家人或朋友戒烟的比例明显高于吸烟者,二者差异有统计学意义。通过综合干预,医务人员的吸烟率差异虽无统计学意义,但有好转趋势;控烟态度明显好于干预前,差异有统计学意义（P＜0．05）。结论 目前医务人员的吸烟率较高,控烟意识淡漠,吸烟者和不吸烟者在控烟态度和行为方面存在差异。在医院环境中采取综合干预的方法可以改变医务人员的吸烟行为,提高其控烟意识。     

Nicotine chewing gum in general practice: effect of follow up appointments

Two hundred smokers who were judged by their general practitioner to be motivated to stop smoking were allocated to one of two groups. All were offered an initial appointment at which they were advised to stop smoking and offered nicotine gum. One group then received no further appointments. The other was offered four further appointments over three months. Both groups were followed up at six and 12 months. At one year follow up 15.5% overall had stopped smoking, 14% in the low and 17% in the high contact group. This is better than most results so far reported for nicotine chewing gum in general practice, suggesting that general practitioners can use it to good effect. We compare this result with others achieved in general practice.     

Pragmatic, observational study of bupropion treatment for smoking cessation in general practice

Background: Cigarette smoking remains the single largest cause of premature death in the United Kingdom. As part of the government''s national service framework for coronary heart disease, smoking cessation forms a key part of the strategy. Objectives: To determine the effectiveness of bupropion treatment for smoking cessation in a general practice setting, measuring continuous abstinence from smoking, from 8 weeks to 52 weeks. Design: Prospective observational study. Setting: One general practice (six whole time equivalent doctors, 11 070 patients) in rural Northumberland. Subjects: Of the 243 patients who presented to the practice over a one year period for smoking cessation, a total of 227 motivated people, who were appropriate for bupropion treatment as a pharmacological aid for smoking cessation, entered the study. Continuous smoking cessation at one year was validated by an exhaled carbon monoxide level of 10 ppm or less. Results: Fifty patients successfully gave up smoking, giving a one year smoking cessation prevalence with bupropion of 22% (95% confidence intervals (CI) 17% to 28%). There was no difference in success rate for sex, number of cigarettes smoked, the number of years smoking, or whether there were other smokers in the household or not. Conclusion: Bupropion treatment in this general practice helped 22% of motivated people to quit and remain stopped smoking at one year. Mainly nurses, whose prescribing rights are restricted and currently exclude bupropion, deliver smoking cessation services in primary care.     

Smoking behaviour, knowledge and opinion of medical students

On the basis of a questionnaire on smoking behaviour, knowledge and attitudes administered to medical students in the University of Malaya in July 1987, the prevalence of smoking was found to be low (10%) among medical students. Smokers and non-smokers were equally well informed about common smoking complications. Most students, irrespective of smoking status, felt that they would as future doctors, often advise sick smokers against smoking. In contrast, less than half would do so for healthy smokers who do not themselves raise the question of smoking. The students' personal smoking behaviour also influenced their view of their professional role. Appropriate values, attitudes and a preventive approach towards smoking need to be further developed in the medical students' thinking and behaviour.     

Facilitating prevention in primary care

We believe that many general practitioners would practice preventive medicine if they had the opportunity to organise their practice to do this. We therefore provided a "facilitator," who understands the work of a general practice, to help practices that were interested in prevention to set up programmes. She, for example, helped the primary care team to set up objectives, trained practice nurses to measure blood pressure, and set up a system to measure the progress of the programme.     

乡村医护人员对全科医学教育需求的调查分析

目的 了解乡村医护人员对全科医学的需求,探讨开展全科医学教育的必要性.方法 采用抽样调查的方法,抽取部分乡镇及其所属村卫生室的医护人员以及部分家庭成员,采取调查问卷、座谈、走访等方式进行调查,了解医护人员的基本信息以及对全科医学教育的需求状况;了解群众参加新农合情况、就医地点、对基层医疗机构的满意度等.结果 临沂市乡村医护人员中,获得本科学历的医生只占9.86％,护士只有3.13％;具有高级职称的医生只占4.23％;年龄在30岁以下者只占13.04％ ;88.35％的医护人员没有参加过全科医学培训.被调查的村民中,99.02％的家庭参加了新农合,73.53％的就医地点选在乡村卫生室,有45.10％的家庭对乡村医疗服务不满意.结论 乡村医护人员接受全科医学教育是当务之急.     

How people with chronic illnesses view their care in general practice: a qualitative study

OBJECTIVES: To explore the perceptions of patients with chronic conditions about the nature and quality of their care in general practice. DESIGN: Qualitative study using focus group methods conducted 1 June to 30 November 2002. PARTICIPANTS AND SETTING: 76 consumers in 12 focus groups in New South Wales and South Australia. MAIN OUTCOME MEASURES: Recurring issues and themes on care received in general practice. RESULTS: Three groups of priorities emerged. One centred on the quality of doctors, including technical competence, interpersonal skills, time for the patient in the consultation and continuity of care. A second concerned the role of patients and consumer organisations, with patients wanting (i) recognition of their knowledge about their condition and self-management, and (ii) for GPs to develop closer links with consumer organisations and inform patients about them. The third focused on the practice team and the importance of practice nurses and receptionists. CONCLUSION: GPs should consider the amount of time they spend with chronically ill patients, and their interpersonal skills and understanding of patients' needs. They need to be better informed about the benefits of patient self-management and consumer organisations, and to incorporate them into their care. They also need to review how their practice nurses and receptionists can maximise the care of patients.     

Behavioral and pharmacological treatment methods for pregnant smokers: issues for clinical practice

Active and passive exposure to tobacco smoke are the most serious and preventable causes of poor maternal, fetal, and infant outcomes in the United States. Unfortunately, the majority of pregnant smokers do not quit smoking before or during pregnancy or after childbirth. We describe a standardized behavioral counseling model and discuss issues to consider in recommending the use of pharmacotherapy during pregnancy. Although the Food and Drug Administration no longer classifies nicotine replacement therapy (NRT) as contraindicated during pregnancy, precautions should be carefully considered for use in this population. This paper provides a synopsis of the risks of exposure to tobacco smoke during pregnancy and the postpartum; estimates the population at risk and the potential for increased cessation if effective health education methods during pregnancy were routinely provided; presents a meta-analysis of "best practice" patient education methods for pregnant smokers; and estimates the number of pregnant heavy smokers who might be eligible for NRT. We suggest five issues for the physician to consider before recommending NRT medications to pregnant patients who are heavy smokers. The judicious use of NRT medications may significantly reduce harm to the infants of heavy smokers. More evidence derived from large population-based research, however, is needed to provide guidance to the physician about NRT eligibility, dose, scheduling, and effectiveness in clinical practice.     

Practice nurses in Australia: current issues and future directions

Almost 60% of general practices now employ at least one practice nurse. Australian Government initiatives to support the expansion of practice nursing are not consistently based on strong evidence about effectiveness, outcomes or efficiencies. Reviews from other countries suggest that practice nurses can achieve good health outcomes, but there is little information about the Australian practice-nurse workforce, funding models to support their work, scope of their practice, or its outcomes. Australian practice nursing lacks a career structure and an education framework to advance nurses' skills and knowledge. To maximise the contribution of nurses in primary care, a more systematic approach is needed, with a stronger evidence base for policy to support effective outcomes.     

广州地区三甲医院呼吸科护士控烟知识态度行为的调查

目的 了解广州地区三甲医院呼吸科护士控烟知识、态度和行为的现状,探讨影响护士开展控烟干预的因素以及护士对控烟培训课程的需求,为护士实施控烟干预提供依据。 方法 采用横断面设计,于2013年10—12月使用自制护士控烟知识态度行为调查问卷对10所三级医院的呼吸科/综合内科护士进行调查。统计控烟知识问题回答正确率、护士对戒烟的态度问题的肯定人数,护士控烟行为的各选项人数分布,并以性别、年龄、工作年限、最高学历、技术职称、科室、工作性质为自变量,以控烟知识4个部分的成绩为因变量进行方差分析以考察自变量各维度在控烟知识上的差异。 结果 控烟知识个领域分数上,因科室、年龄、工作性质及学历等因素不同而高低不同。愿意参加控烟相关工作的护士人数几乎占90%,愿意参加控烟相关培训的人数超过85%,而表示愿意主动了解控烟知识的人数仅有73.8%。95%以上的护士都认为应该积极参与控烟和应该向病人提供戒烟指导的认识。 结论 目前广州地区医院呼吸科/综合内科护士对控烟态度和行为都较积极,但相关控烟知识比较薄弱,需进一步加强护士的控烟意识、相关知识教育和技能培训,有助于发挥护士在控烟中的重要作用。      

A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I

Sixty-six physicians were randomized to three groups to conduct a 1-month campaign to help their patients stop smoking. The workshop group received free patient education materials and a 6-hour training workshop. The materials group received free patient education materials, and the no-assistance group received nothing. A telephone interview was completed with 89% of the 6767 eligible adult patients seen during the month of the campaign. The brief training program and patient education materials marginally increased the smoking intervention activities of volunteer physicians in private practice. Both workshop and materials physicians asked 54% of their smoking patients to stop; no-assistance physicians asked 40%. One year later, 36% of patients who had not even been asked by their doctors if they smoked reported that they had tried to stop smoking. If the physician had asked the patient if he or she smoked, the probability of a quit attempt was 47%. Patients who had been asked if they smoked were more likely to claim to have stopped (13%) than patients who had not been asked (9%). However, the proportion of patients claiming continued abstinence (range, 12% to 14%) was not related to the group of the physician.     

General practitioners' detection of patients' smoking status

We examined the detection of smoking by 50 randomly-selected general practitioners. The practitioners said that they should detect smokers among their patients with a high degree of accuracy: a median of 100% of smokers under ideal conditions, and a median of 80% of smokers given the realities of practice. Practitioners actually identified 56.2% of their patients who were smokers--360 of 641 smokers among 2044 patients in the study. Some 65% of patients with a smoking-caused or smoking-exacerbated disease were detected, and this degree of detection was not related to age. For smokers of greater than 50 years of age and without any obvious smoking-related condition, the detection rates were similar to those of patients with smoking-related disease; however, in those patients who were less than 30 years of age, only 41% of smokers were detected--although the prevalence of smoking was higher in the younger than it was in the older patients. For all age-groups, the prevalence of smoking in men was about 15% higher than it was in women, but there was no significant difference between the detection rates in the sexes. In spite of their higher risks from smoking, the detection rates for pregnant women, or women who were taking oral contraceptive agents, were no higher than those for other women of less than 35 years of age. The doctors said that they had treated for smoking 78% of the detected smokers who had smoking-caused disease, compared with 35% of detected smokers with no smoking-related condition. They rated the value of such treatment higher in the former group than in those patients who had not yet developed smoking-related problems. Doctors appear to respond to the evidence of disease that is caused by smoking more than to the habit itself, which is a handicap in the prevention of smoking-related disease.     

西安市居民吸烟行为流行病学分析

目的　了解西安市居民的吸烟现状 .方法　随机抽取 10 0 0名 15～ 6 9岁居民进行入户调查 .结果　西安市居民吸烟率为 32 .2 % (男 6 4.2 % ,女 1.8% ) ,平均开始吸烟年龄为2 2 .5岁 ,日平均吸烟量为 12 .8支 ,且开始吸烟年龄越早 ,吸烟量越大 ,尝试、社交需要和解乏是主要的吸烟原因 ,吸烟者的戒烟率为 9.0 3% .分析发现 ,性别、职业、文化程度及家庭成员吸烟均与居民的吸烟行为有关 .结论　吸烟在西安市仍然是一个严重的公共卫生问题 ,控烟应从全社会抓起 ,以青少年作为宣传教育的重点 ,加强控烟力度     

浙江省某市三级医院医护人员健康教育知信行调查

目的了解浙江省某市三级医院医护人员健康教育知识、信念、行动情况，分析医护人员健康教育工作中存在的问题，并提出合理建议。方法采用分层随机抽样方法，运用自编问卷对医院的322名医护人员进行调查。结果不同学历、职业的医护人员健康教育知识知晓率存在差异（P〈0．05）。322名被调查者中，92．8％的被调查者认为在医护活动中实施健康教育很重要，60．5％的被调查者在医护工作中经常给病人讲解疾病预防的知识，57．1％的人会经常对病人的不良行为进行干预，参加过医院或专门健康教育机构组织的培训班的占73．6％，94．1％的被调查者愿意进一步接受专门的健康教育培训。结论很有必要提高医护人员健康教育培训率和广大医务人员的健康教育水平。     

Study of knowledge, attitude and practice concerning aspects of torture

The report presents the first attempt of the IMA-AKN Sinha Institute of continuing medical and health education and research to study the knowledge, attitude and practice of doctors regarding torture. Although, majority of the doctors in India are aware of various national and international human rights institutions, but they seem not to be aware of the human rights of the detainees. It is interesting to note that the doctors are aware of the long term physical and psychological effects of torture and also agreed that physical examination is not sufficient to detect torture sequelae. A large number of doctors have seen cases of torture, and were willing to treat them and felt reasonably competent. A significant number of doctors justified use of coercive technique and manhandling in dealing with detainees by law enforcement agencies. A small number of doctors expressed their unwillingness to get involved in the treatment of the victims of torture due to medicolegal consequence. The dissemination of information on human rights and medical ethics and incorporating them into the medical curriculum at undergraduate and postgraduate training was emphasised by majority of the respondents. Almost unanimous view was expressed by respondents on the importance of the role of medical ethics and the profession's responsibility to its members. An important finding of the study is the need for IMA to help establishing counselling and rehabilitation centres for treatment of torture victims and educate its members. A large number of doctors mentioned the need of initiating community action in case of rape, child abuse, dowry victims and sexual harassment. Further, a majority of respondents expressed the view that the medical association should take the responsibilities of protecting the doctors who fearlessly testify cases of torture besides disciplining doctors who facilitate torture. Respondents felt that the reasons for doctors' participation in torture need further study. It is encouraging that most of the responding physicians are willing to take up training and become counsellor for victims of torture to be able to provide treatment, counselling and rehabilitation.