以醫病共享決策模式提升戒菸療程完成率

Shared Decision Making Model Improves the Completion Rate of Smoking Cessation Treatment

吸菸及二手菸、三手菸對健康的影響及環境有毒物質的累積危害，是全世界都重視的可預防因子。吸菸對身體的危害，是全身性的影響，除了熟知的肺部疾病、心血管疾病、糖尿病、甲狀腺、不孕症、皮膚疾病、胃食道逆流及潰瘍、口腔疾病以及多數癌症有相關。本案旨在提升戒菸療程完成率，分析發現：戒菸療程完成率低之主因為：對戒菸知識瞭解程度不足、醫師缺乏足夠時間於門診詳細解釋衛教、沒有適當的空間向病人衛教、醫病溝通缺乏有效率的紀錄平台，無法追蹤。改善措施：搜尋戒菸相關之文獻建立SDM模型、依病人就醫流程研議介入時機、執行SDM、增加人力（衛教師）、設置專屬戒菸衛教室、透過院內REDCap系統建立線上版PDA工具及建立QR code電子化紀錄功能。結果：以醫病共享決策流程實施後，三個月點戒菸成功率自改善前39.1％提升為53.9％。六個月點戒菸成功率自改善前37.6％提升為40.7％，第一療程完成率自改善前45.8％提升為56.6％，第二療程完成率自改善前67.9％提升為75.0％。有效提升戒菸療程完成率及提升照護品質。

Smoking, second-hand smoke, and third-hand smoke related burden of disease and environmental influences are severe preventable threats to worldwide public health. Smoking harms almost every organ system of the body, and increases risks of respiratory diseases, cardiovascular disease, diabetes mellitus, thyroid disease, infertility, dermatological disease, gastrointestinal disease, dental disease, and cancers etc. The project aimed to increase the smoking cessation rate, and several factors were identified by group discussion including insufficient knowledge about smoking cessation, lack of time and space in outpatient clinic for patient education, ineffective physician patient communication. The improvement procedures of the project included establishment of shared decision making model including suitable timing of intervention, more personnel, smoking cessation consultaion room, and online patient decision aid. After the project, the point smoking cessation rate improved from 39.1% to 53.9% for 3 month, and 37.6% to 40.7% for 6 month. The treatment completion rate increased from 45.8% to 56.6% for first course, and 67.9% to 75% for second course. The application of shared decision-making model effectively increase the treatment completion rate and smoking cessation rate.