住院與門診不同戒菸場域對於吸菸病人三個月戒菸成功率之影響

Inpatient vs. Outpatient: Influences of Setting on Successful Rate of 3-month Smoking Cessation

目的：本研究擬探討住院與門診不同戒菸場域對於吸菸病人三個月點戒菸成功率之影響。

方法：本研究採病歷回溯法，以2017年1月1日至2017年12月31日完成3個月追蹤點戒菸者為研究對象，共計1,667位吸菸者，除戒菸介入場域，包括門診及住院變項之外，另包括下列變項資料：1)基本資料：年齡、性別、身高、體重、婚姻、運動習慣、喝酒、嚼檳榔習慣；2)吸菸相關因素：開始吸菸年齡、平時菸量、過去戒菸情況、尼古丁成癮度；3)戒菸介入方式：衛教次數、戒菸用藥等變項。統計分析是以多變項邏輯斯迴歸分析住院與門診不同戒菸場域與3個月追蹤點戒菸成功之獨立的相關性。

結果：1,667位個案之中，住院期間啟動戒菸服務者1,035位(62.1%)，門診就醫啟動戒菸服務者632位(37.9%)，有685位戒菸成功(41.3%)、982位戒菸失敗。單變項分析顯示門診和住院組的戒菸成功率存在顯著差異（門診組36.1%和住院組44.2%，p=0.001）；多變項分析結果如下，3個月追蹤點戒菸有無成功之相關獨立因子為啟動戒菸服務之場域（住院 vs. 門診：OR 2.3，95% CI 1.8-3.1，p<0.001）、戒菸用藥治療週數（≥4 vs. <4週：OR 2.3，95% CI 1.5-3.5，p<0.001）、衛教師衛教次數（OR 1.3，95% CI 1.1-1.4，p<0.001）、婚姻狀態（已婚 vs. 單身：OR 1.3，95% CI 1.0-1.7，p=0.032）、開始吸菸年齡（≥18 vs. < 18歲：OR 1.6，95% CI 1.3-2.0，p<0.001）、尼古丁成癮度分數（OR 0.9，95% CI 0.8-0.9，p<0.001）、目前嚼檳榔習慣（否 vs. 是：OR 1.6，95% CI 1.1-2.3，p=0.015）、目前喝酒習慣有關（否 vs. 是：OR 1.3，95% CI 1.0-1.7，p=0.019）。

結論：就戒菸成功相關因素而言，除了考量病人的特性、衛教次數、戒菸用藥等以外，住院相較於門診場域戒菸介入有2.3倍的3個月點戒菸成功率，因此宜把握吸菸病人住院期間的戒菸介入時機，會更有助於提高戒菸成功率。

 

Objectives: To examine the association of setting—inpatient vs. outpatient—with success rate of 3-month smoking cessation.

Methods: A retrospective chart review was conducted based on collected data of smokers receiving a 3-month follow-up at National Cheng Kung University Hospital from January to December 2017. The outcome variable was self-reported 7-day point prevalence tobacco abstinence at the 3-month follow-up. The predictor variables were settings (inpatient vs. outpatient), baseline data, smoking-related factors, and smoking cessation intervention.

Results: A total of 1,667 subjects were enrolled, including 1,035 inpatients (62.1%) and 632 outpatients (37.9%). At the 3-month follow-up, the rate of abstinence was 41.3%. In univariate analysis, there was a significant difference in the abstinence rate between the outpatient and the inpatient groups (outpatient 36.1% and inpatient 44.2%, p=0.001). In multivariate analysis, inpatient intervention achieved greater abstinence than outpatient intervention at the 3-month follow-up (odds ratio 2.3, 95% confidence interval 1.8-3.1, p<0.001). Positive factors associated with abstinence were as follows: pharmacotherapy ≥ 4 weeks (odds ratio 2.3, 95% CI 1.5-3.5, p<0.001), number of counselling (odds ratio 1.3, 95% CI 1.1-1.4, p<0.001), marital status (married vs. single; odds ratio 1.3; 95% CI 1.0-1.7, p=0.032), and age of starting smoking ≥ 18 y/o (odds ratio 1.6, 95% CI 1.3-2.0, p<0.001). By contrast, high dependence score (odds ratio 0.9; 95% CI 0.8-0.9, p<0.001), and habits of chewing betel nuts (no vs. yes; odds ratio 1.6; 95% CI 1.1-2.3, p=0.015) and alcohol drinking (no vs. yes; odds ratio 1.3; 95% CI 1.0-1.7, p=0.019) were negatively related to tobacco abstinence.

Conclusion: In addition to smoker’s characteristics, counselling and medication for smoking cessation, inpatient intervention achieves a success rate 2.3 times greater than outpatient intervention. Thus, hospitalization can be a timing of smoking cessation intervention that should be seized to improve the abstinence rate of smoking cessation.