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研究生:陳稚尹
研究生(外文):Chih-Yin Chen
論文名稱:家庭醫學科門診戒菸率之長期研究
論文名稱(外文):Smoking cessation therapy in Family Medicine clinics: A longitudinal study
指導教授:黃芷苓黃芷苓引用關係
指導教授(外文):Chih-Ling Huang
學位類別:碩士
校院名稱:長榮大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:98
中文關鍵詞:戒菸門診
外文關鍵詞:Smoking cessationClinic
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2006年台灣成人男性吸菸率39.1%,女性吸菸率4.12%,估計台灣有超過四百萬的吸菸人口,因此戒菸研究仍是國內重要的健康議題。我國於2002年9月1日起行政院衛生署國民健康局開始展開「門診戒菸治療試辦計畫」,提供門診個案尼古丁替代藥物及行為短暫諮商的短期治療服務。國外於門診戒菸治療已有長期之追蹤,國內大部分研究只有單組實驗,缺乏控制組且無一年以上長期追蹤。目前國內門診戒菸的研究,以醫學中心戒菸成功率最高,醫學中心又以家庭醫學科為主要實施戒菸治療的單位。故本研究設計為縱貫性研究,採立意取樣,研究對象為南部某醫學中心家醫科門診戒菸病患,自2002年9月1日起共追蹤三年,有效樣本共772位。另一研究自2008年1月1日起共追蹤一年的兩組設計,有效樣本共80人。目的為瞭解家醫科門診戒菸治療三年戒菸成效及復發的影響因素,另一研究目的為比較門診提示系統下門診病患於家醫科門診戒菸治療與一般門診病人自助戒菸的ㄧ年戒菸成效。本研究主要結果為在三年追蹤戒菸過程中,一個月、三個月、六個月、一年、三年的點戒菸率為99.7%、49.2%、37.7%、30.3%與22.7%,最容易復發期間為戒菸日到三個月期間,一天吸菸支數與參加的門診次數是預測復發重要的危險因子。一年戒菸成果發現,治療組的戒菸率為對照組的1.6倍(95%CI for OR=0.55-4.88)。由結果來看,建議門診戒菸治療初期三個月內發展有效預防復發的策略,可以在治療期間增加有效的追蹤方式,提醒個案回診時間並適時提供所需要的諮詢,以提升門診長期戒菸率。兩組設計的研究結果,雖然未達到統計上的顯著差異,但這是國內第一篇探討在門診提示系統下的戒菸率比較,仍屬於前驅性研究階段,未來研究應該增加樣本數及追蹤時間,進一步評估門診提示系統對於民眾吸菸行為的影響。最後,國外已有多篇長達五年以上戒菸門診追蹤的研究,未來國內應可以進行更長期追蹤研究,以加強長期戒菸成效。
The prevalence of male and female smoking in Taiwan in 2006 was 39.1% and 4.12% respectively. It is estimated over 4 million population smoking in Taiwan. A smoking cessation program in clinics has been implemented and funded by the Bureau of Health Promotion, Department of Health since September 1, 2002. The program focuses on dealing with nicotine withdrawal symptoms, in combination of brief counseling and nicotine replacement therapy in outpatient departments. A longitudinal study for smoking cessation program was already conducted in other countries. However, the present studies in Taiwan lack comparison groups and over one-year follow-up. Previous studies showed that the medical center had the highest cessation rate in Taiwan. Most smoking cessation services were implemented in the Family Medicine department. This study is a descriptive and longitudinal study with 3-year follow-up since September 1, 2002. The purposive sampling was used and the effective sample size is 772. The design of another study was two-group comparison with one year follow-up since January 1, 2008. The effective sample size in this pilot study is 80. The subjects were recruited from a medicine center in Family Medicine smoking cessation clinic. The aim of this study is to evaluate smoking cessation therapy in Family Medicine clinics in a three-year telephone follow-up and to determinate the relapse factors influencing cessation rates. In addition, the aim of another study is to compare the cessation rates of outpatient in Family Medicine clinics with other clinics outpatients. The main results of our study revealed that the point abstinence rates after quit day at one month, three months, six months, one year and three years were 99.7%, 49.2%, 37.7%, 30.3% and 22.7%, respectively. The important risk factors to predict relapse are the number of cigarettes per day and the number of attending outpatient services. Our pilot study showed that the smoking cessation rate in intervention group is 1.6 times(95%CI for OR=0.55-4.88) over control group during one year follow up. According to our result, we suggest to develop the effective strategies in the initial 3 months of outpatient treatment to prevent smoking relapse. The clinics can provide effective follow-up strategies in therapeutic period, remind the patients for next visit and implement appropriate counseling to enhance the rates of long term cessation in outpatient services. The results of two-group design showed no significant difference. However, this is the first paper in Taiwan to evaluate the effect of warning system in outpatient service for smoking cessation. It still is in the stage of pilot study. Future research needs to increase the sample sizes and longer follow up to evaluate the effect of the system on smoking behavior. Finally, there are several smoking cessation clinic studies with more than five-year follow up in other countries. Longer follow-up studies are suggested to evaluate the effectiveness of smoking cessation to improve the services of smoking cessation.
第一章 緒論................................................................................................... 1
第一節 研究背景與動機......................................................................... 1
第二節 研究目的..................................................................................... 3
第二章 文獻查證........................................................................................... 4
第一節 戒菸率的測量與準則................................................................ 4
第二節 戒菸措施與成效........................................................................ 5
第三節 我國門診戒菸治療試辦計畫之介紹........................................ 11
第四節 國內外戒菸門診之文獻回顧.................................................... 12
第三章 研究方法........................................................................................... 30
第一節 研究對象.................................................................................... 30
第二節 研究設計.................................................................................... 32
第三節 研究架構與名詞定義................................................................ 33
第四節 研究工具.................................................................................... 35
第五節 研究倫理.................................................................................... 38
第六節 資料收集過程............................................................................ 39
第七節 資料分析方法............................................................................ 41
第四章 研究結果........................................................................................... 44
第一節 研究對象之描述性統計............................................................ 45
第二節 戒菸門診之三年存活分析結果................................................ 46
第三節 門診患者治療組與對照組一年之戒菸率比較之結果............ 58
第五章 討論................................................................................................... 59
第一節 門診戒菸治療患者的基本人口學特性.................................... 59
第二節 基本人口學、吸菸情況與門診療程三年戒菸率之比較.......... 60
第三節 影響門診戒菸治療的復發因子................................................ 66
第四節 治療組與對照組的ㄧ年戒菸率比較........................................ 67
第六章 結論與建議....................................................................................... 68
第一節 結論............................................................................................ 68
第二節 限制與建議................................................................................ 69
參考文獻......................................................................................................... 71
圖..................................................................................................................... 47
圖一................................................................................................................. 47
圖二................................................................................................................. 48
圖三................................................................................................................. 50
圖四................................................................................................................. 51
圖五................................................................................................................. 52
圖六................................................................................................................. 53
圖七................................................................................................................. 54
表一 研究對象人口學基本資料................................................................... 82
表二 門診戒菸患者之三年存活分析........................................................... 83
表三 基本人口學、吸菸情況與門診療程三年存活曲線之比較................. 84
表四 門診戒菸患者之三年風險模型分析................................................... 87
表五 門診病患治療組與對照組之年齡與吸菸支數的關係....................... 88
表六 門診病患治療組與對照組之性別與戒菸率的關係........................... 88
表七 門診病患治療組與對照組的戒菸勝算比........................................... 88
附件................................................................................................................. 89
附件一 戒菸服務補助計畫個案紀錄表(2005年10月以前) ...................... 89
附件二 戒菸服務補助計畫個案紀錄表(2005年10月之後) ...................... 90
附件三 戒菸行為分析問卷........................................................................... 91
附件四 個案成功率追蹤問卷....................................................................... 92
附件五 門診作業提醒系統作....................................................................... 95
附件六 IRB同意函........................................................................................ 96
附件七 GCP結業證書................................................................................... 98
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