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研究生:謝寧惠
研究生(外文):Ning-Huei Sie
論文名稱:全國醫院臨床戒菸服務與其支持系統之現況調查
論文名稱(外文):Provision of Smoking Cessation Services and Availability of Organizational Support in Taiwan’s Hospitals- A Nationwide Survey
指導教授:邱淑媞邱淑媞引用關係
指導教授(外文):Shu-Ti Chiou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:131
中文關鍵詞:臨床戒菸戒菸門診門診戒菸治療計畫
外文關鍵詞:clinical smoking cessationsmoking cessation clinicOutpatient Smoking Cessation Program
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目的:臨床戒菸服務是降低吸菸率的重要介入策略,本研究之目的為調查全國各層級醫院戒菸服務之提供狀況以及其相關支持性系統之發展情形。
方法:本研究以結構式問卷對全國醫院進行橫斷性調查,內容包括:醫院特性、醫院戒菸臨床作業系統、醫院具備各項戒菸資源情形及醫院戒菸管理政策現況。研究對象為:全國所有醫學中心 (23家) 和區域醫院 (85家),並以系統性隨機抽樣出1/3地區醫院 (423家),合計249家。問卷採自填式回答,各醫院均於問卷寄發前先以電話個別確認填答人,問卷調查期間為2009年1 月11日至4月5日,問卷共寄出三次,以提高回收率。
結果:總計回收有效問卷172份,回收率69.9%。依回收樣本各層級醫院之數值推估全國數值,有國健局門診戒菸合約者為72.9%,各院平均有2.9位醫師獲戒菸認證資格,實際執行服務之醫師有61.7%,每千床一年提供之戒菸服務人次為233.9人。有84.6%醫院於一般門診中提供門診戒菸服務,有14.9%具有門診主動提示電腦系統,其中醫學中心占43.8%、區域醫院為26.2%、地區醫院為11.1%;其輸入者八成以上為醫師。僅三成醫院有提供戒菸標準流程或戒菸指引供醫療人員遵行,和26.4%醫院有推廣戒菸的全院性政策或計劃。醫院戒菸臨床作業系統、醫院具備各項戒菸資源情形及醫院戒菸管理政策,在醫學中心、區域醫院及地區醫院間的表現大多具顯著差異,且以醫學中心和區域醫院表現較佳。醫院在戒菸工作中遇到的主要困難為病人因素,並且最希望政府或民間團體應首要加強教育宣導及輔導以及改善戒菸治療給付政策。
結論:目前全臺醫院對於戒菸相關政策尚不足,建議醫院應將戒菸服務視為醫院重要發展之ㄧ,讓醫院工作人員推動戒菸服務時可獲得較多支持。地區醫院是功能上最應該提供預防性服務的醫院,但院內戒菸體系之發展亦最不足夠,建議政府應加強對社區醫院之輔導。政府也應全面提倡戒菸的好處,並主動宣導門診戒菸治療服務相關的資訊,讓全國民眾對於戒菸有正面的認知。本研究已建立全國性戒菸服務現況之基礎資料,將可作為未來追蹤國家政策或全國性介入計畫成效之比較依據。
Objective: Clinical smoking cessation serivce is an important strategy to reduce smoking rate. The purpose of the study is to understand the provision of smoking cessation services among different type of hospitals and the availability of organizational support in Taiwan.
Method: To investigate the hospitals with a structured questionnaire, which contains the charateristics of hospitals, availability of smoking cessation services the past year, clinical delivery system, resources, policy and management of smoking cessation. The study targets: all medical centers (23), all regional hospitals (85) and 1/3 district hospitals (423) were selected by systematic random sampling; the total sample size is 249 hospitals. Before sending questionnaires we confirmed with the coordinators, the period of survey during 2009/1/11 to 2009/4/5. During the survey period, we sent the questionnires for 3 times, in order to have higher response rate.
Result: The total valid questionnaires were 172 and reponse rate 69.9%. According to the numbers of estimated for the whole Taiwan by the response questionnaires, there were 72.9% hospitals contracted by Outpatient Smoking Cessation Program of Bureau of Health Promotion; the average contracted smoking cessation physicians was 2.9, 61.7% physicians practice smoking cessation service, and adjusted annual services per 1000 beds was 233.9. There were 84.6% hospitals that had provided outpatient smoking cessation service in general clinics. In the outpatient department, 14.9% hospitals had computerized based reminder system, in the medical centers, regional and district hospitals were 43.8%, 26.2% and 11.1%, respectively. More than 80% of the recoders for reminder system were physicians. Only 30% hospitals provided smoking cessation guideline to providers and 26.4% had written smoking cessation policies or protocols in hospitals. In most smoking cessation services, resources, and policy were significantly different among these three hospial levels. The most important difficulty during providing smoking cessation service was the patient internal factors, and these hospitals hoped govenmetnt or NGOs could strengthen the educational propagation and improve the smoking cessation treatment reimbursements.
Conslusions: Due to the shortage of smoking cessation policies in hospitals, we suggest that hospitals should focus on the development of smoking cessation services to support clinicians while they provide smoking cessation services. In principle, district hospitals should provide more preventive services than other type of hospitals; however, the lack of development of smoking cessation system we suggests that government should make more effort to assist community hospitals. Also, government should promote the outpatient smoking cessation services so that people can increase their knowledge on smoking cessation. The study provides information regarding the current status of clinical infrastructure for smoking cessation services in Taiwan. It also serves as the basis for international comparison as well as for longitudinal follow-up of progresses.
摘要 i
Abstract ii
目錄 iv
表目錄 v
圖目錄 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 6
第三節 研究之重要性 7
第二章 文獻回顧 9
第一節 戒菸對健康的影響 9
第二節 專業醫療人員在戒菸服務提供上所扮演的角色 11
第三節 有效的戒菸服務 13
第四節 臨床戒菸政策與支持系統 21
第五節 研究架構 26
第三章 研究方法 27
第一節 研究設計 27
第二節 研究對象與資料收集 27
第三節 研究變項 30
第四節 資料分析 37
第四章 結果 38
第一節 研究樣本之基本描述 38
第二節 各類因素與醫院戒菸服務量之關係 50
第三節 各類因素與醫院感受的戒菸困難度之關係 53
第四節 與醫院戒菸服務量及醫院感受的戒菸困難度有關之多變項分析 55
第五章 討論 59
第一節 重要研究結果討論 59
第二節 研究限制 66
第六章 結論與建議 68
第一節 結論 68
第二節 建議 70
對政府之政策建議 70
對醫院之建議 70
參考文獻 71
附錄一、專家名單 77
附錄二、問卷 78
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