國民健康局「門診戒菸服務計劃」在基層醫療院所實施之成效 - 以某診所為例

摘要目的台灣的吸菸人口約489萬人，死亡原因中有20%是吸菸引起，每年有165億元之健保支出用於治療吸菸相關疾病，整體經濟損失約500億(不含二手菸危害.長期復健照顧.輔助性醫療等)衛生署國民健康局於91年9月開始推動[門診戒菸治療服務計劃]目的是希望降低吸菸人口。本研究目的旨在分析醫護人員提供戒菸教育及戒菸貼片(介入措施)，對戒菸組及控制組抽菸量改變之情形。材料與方法採類實驗分析及問卷前測､後測的方式。研究對象為二年來在本診所有意戒菸者(N=200人)暫無意願戒菸者(N=199人)兩組。研究變項含吸菸年數､每天抽菸量､尼古丁成癮度､基本認知(知識､態度､行為等)，資料分析以Excel軟體做篩選，採用SPSS10.0版統計軟體進行描述性及推論性統計。結果 1.大部分參加者為初次進行戒菸，尤以戒菸組最為明顯，其人數佔組內的79.2%。且在兩組比較之後，χ2 =8.964、p=.011。吸菸年數在戒菸組平均值是10.47年，控制組平均值是8.23年，t=2.740 P=0.006。兩組間有顯著差異，戒菸組平均吸菸年數比控制組長。 2.在探討不同組別戒菸組及控制組在介入前後這兩個因子對平均吸菸量的影響。重複測量兩次的結果 F=11.530 P=0.001。重複測量三次的結果 F=121.255 P=0.000不管戒菸組或控制組，吸菸量皆有顯著的下降，而戒菸組在介入後其吸菸量減少的情形，較控制組顯者，而且介入期愈長效果愈好。其前後三次測量比較所得到的結果，F=121.255、 P=0.000。戒菸組下降的趨勢尤其明顯，而且追蹤期愈長效果愈好。結論與建議吸菸相關疾病耗用相當可觀的醫療資源，如何降低吸菸人口成為一個公共衛生學及醫療經濟學上的重大課題，基層診所如能深入社區､學校､工廠､推廣戒菸教育､提供民眾方便的戒菸環境，相信促進國人健康有莫大的幫助。關鍵詞：門診戒菸､吸菸相關疾病､醫療介入措施､戒菸貼片。

關鍵字

門診戒菸；吸菸相關疾病；醫療介入措施；戒菸貼片

並列摘要

Abstract Objective The smoking population in Taiwan is around 4.89 million. There are 20% of the causes of death attributed to smoking. About 16,500 million NT dollars of the expenditure of National Health insurance is for treating smoking relevant disease. Whole economic losses are about 50 billion (do not include Environmental Tobacco Smoke, long-term respiratory care, complementary medical treatment, etc.). Bureau of Health, Department of Health, began to promote Outpatient Smoking Cessation Program (OSCP) in September 2002. The goal of it is to reduce population of smoking. The purpose of this research was to evaluate that the changing of smoking amount after the intervention of quit smoking education with or without nicotine patch (one kind of nicotine replacement therapy). Materials and methods Quasi-experimental pre-post two groups design was used in this study. The quit smoking group was patients who intended to quit smoking (n=200) over the past two years and the control group who didn’t (n=199). The research variables included smoking history, daily smoking amount, nicotine addiction degree, basically cognition (knowledge, attitude, behavior, etc). The data was screened in Excel software, and analysis in SPSS10.0 version software to carry on the descriptive and inferential statistics. Results 1. Most participants were the first time to quit smoking, particularly in quit smoking group accounting for 79.2%. After comparing in two groups (χ2=8.964, p=.011), the average duration of quit smoking group was 10.47 years, and the control group was 8.23 years. There was a significant difference between two groups, and the average duration of quit smoking group is longer than control group. 2. To investigate whether the group and intervention influenced average smoking amount. Result of repeated measures two-way ANOVA was F=11.503, p=.001and three-way was F=11.503, p=.001. Whether quit smoking group or control group, the smoking amount all declined apparently. The quit smoking group was significantly reducing in the smoking amount than the control group after intervention. The intervention period was longer, the effect was better. Conclusion and suggestions Smoking relative diseases consume plenty of medical resource, so that how to reduce smoking population becomes vital for the public hygiene and medical economics. If primary care units can popularize smoking relative education in the community, school, factory and offers convenient quit smoking environment to the people, we believe that it is helpful in promoting compatriots health. Key words: Outpatient Smoking Cessation Program, Smoking relative disease, Intervention, Nicotine patch.