喫煙する患者にどうするか
1Department of Medicine and Smoking Cessation Leadership Center, University of California, San Francisco 94143, USA. schroeder@medicine.ucsf.edu
JAMA
|July 28, 2005
まとめ
ほとんどの臨床医は,喫煙が予防可能な主要な死因であるにもかかわらず,喫煙者が禁煙するのを助けるのに欠けている. 証拠に基づいた戦略とリソースを活用することで,成功した禁煙率を大幅に改善することができます.
科学分野:
- 公衆衛生は公衆衛生である.
- クリニカル・メディシン 臨床医学
- 依存症 科学 科学 依存症 科学
背景:
- 喫煙は,予防可能な死亡と障害の主な原因であり,米国の喫煙者の70%が禁煙したいと考えています.
- ニコチン依存症は,米国の4,600万人の喫煙者の多くにとって,助けなしに禁煙を困難にします.
- 臨床医は,時間,専門知識,成功率に関する悲観など,喫煙者を支援する障壁に直面しています.
研究 の 目的:
- 禁煙における臨床医の低業績を強調するため.
- 証拠に基づいた禁煙戦略とその有効性を検討する.
- 禁煙における障壁に対処し,より良い臨床実践を促進する.
主な方法:
- 禁煙に関する現在の文献のレビュー.
- 停止のための"5A"モデルの説明.
- 薬物療法とカウンセリングの介入に関する議論.
主要な成果:
- "5A"モデルを利用する医師はごく少数です.
- 薬物中断を成功させるには,多くの場合,複数の試みと併用療法 (カウンセリング + 薬剤療法) が必要です.
- 退薬ラインや統合システムへの紹介は,個々の臨床医の努力と比べ,成功率を比較することができます.
結論:
- 臨床医のサポートは不可欠ですが,しばしば欠けています.
- 簡素な紹介経路を含む,エビデンスに基づいた介入は,禁煙率を大幅に改善することができます.
- 臨床医の悲観主義を成功データで解決することは,禁煙の介入を促進するために不可欠です.
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