臺灣中部某醫學中心門診戒菸治療病患一年追蹤

One-year Follow-up Results of Outpatient Smoking Cessation Therapy at a Medical Center in Central Taiwan

以台灣中部某醫學中心家庭醫學科辦理國民健康局補助的「門診戒菸治療試辦計劃」病患一年追蹤的結果，分析未能戒菸或復燃的危險因子。介入包括治療尼古丁戒斷症的藥物（共八週）、加上兩週一次的門診行為諮商（共五次）、和定期電話追蹤。初診使用自填結構式問卷收集基本資料、SF-36台灣版(SF-36)；以郵寄問卷追蹤目標戒菸日(TQD)後滿三、六、九、十二個月的戒菸狀態（過去四個星期內吸菸狀況）、顧客滿意度、SF-36。118位病人（男109人，女9人）接受尼古丁替代治療（皮膚貼片為第一線）；其中43.3%（51位）接受七週或八週藥物。戒菸率（點盛行率，持續率）分別為滿三個月(44.1%, 44.1%)、滿六個月(40.7%, 32.2%)、滿九個月(33.9%, 25.4%)、滿十二個月(30.5%, 20.3%)。「TQD有嘗試戒菸」的病人(n=87)各追蹤時點戒菸的點盛行率都高鈴「TQD無嘗試戒菸」的病人(n=31)。「TQD有嘗試戒菸」、「門診次數」、「藥物週數」三者間有正相關。Cox對比涉險迴歸模式分析結果顯示「未能戒菸復燃」較低危險性的因子包括較大的「年齡（歲）」、「TQD有嘗試戒菸」、較多的「門診次數」、較多的「藥物週數」。滿六個月時持續戒菸者SF-36的「一般健康狀況」評分，目標戒菸日後滿三個月和滿六個月時都比戒菸前增加。使用以皮膚貼片為第一線的尼古丁替代治療，加上定期門診行為諮商、電話追蹤、和個案管理的整套門診戒菸治療模式，可協助部分吸菸者達成戒菸、並改善健康生活品質。協助病人展開戒菸行動、並促進門診戒菸治療及戒菸輔助藥物八週療程的完成，是門診戒菸治療值得努力的工作。

We report the one-year follow-up results of the Outpatient Smoking Cessation Therapy Preliminary Program, sponsored by the Bureau of Health Promotion at the Family Medicine Outpatient Department (OPD) of a medical center in central Taiwan; we also analyzed the risk factors for failure to quit smoking cigarettes or cigarette smoking relapse. The intervention included 8-weeks of medication for nicotine withdrawal symptoms, 5 fortnightly OPD behavioral counseling sessions, and regular telephone contact. During the first visit, we used a self-administered, structured questionnaire and the Short Form-36 (SF-36) Taiwan version to collect patient characteristics. Follow-up questionnaires queried the patient’s abstinence status (i.e., smoking status during the past 4 weeks) and satisfaction with the program; the questionnaires and the SF-36 were administered by mail 3, 6, 9, and 12 months after the target quit date (TQD). One hundred eighteen patients (109 males and 9 females) received nicotine replacement therapy (NRT) patches as the first-line medication; 43.3% (n=51) of the patients received NRT for 7-8 weeks. The abstinence rates (point prevalence and continuous abstinence) 3, 6, 9, and 12 months after the TQD were 44.1% and 44.1%, 40.7% and 32.2%, 33.9% and 25.4%, and 30.5% and 20.3%, respectively. Compared with their counterparts (n=31), patients who attempted to quit on the TQD (n=87) had a higher point prevalence abstinence 3, 6, 9, and 12 months after the TQD. There were correlations among those who attempted to quit on the TQD, the number of OPD visits, and the weeks of NRT medication. Cox proportional hazards regression model analysis revealed the risk factors for less frequent failure to quit or cigarette smoking relapse as follows: older age, attempting to quit on the TQD, more OPD visits, and longer weeks of NRT medication. Patients who were abstinent both 3 and 6 months after the TQD improved their SF-36 general health scale scores, both 3 and 6 months after the TQD. In general, Outpatient Smoking Cessation Therapy with NRT plus regular behavioral counseling, telephone contact, and case management may help some cigarette smokers achieve abstinence and also improve their health-related quality of life. Assisting patients to initiate action to quit cigarette smoking and facilitating their completion of an 8-week treatment course is worthwhile for OPD smoking cessation therapy.