動機式晤談於精神疾患之戒菸成效-以台灣南部某精神專科醫院為例

The Effects of Motivational interviewing for smoking cessation in Patients with Mental Illness - Based on the Mental Health hospital in South of Taiwan

王雪吟(Hsueh-Yin Wang)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00144

摘要

前言：衛生福利部於2012年3月1日起，推出「實施二代戒菸治療試辦計畫」，由培訓過之高階戒菸衛教人員，運用動機式晤談理論，提供戒菸門診個案衛教諮詢服務，目前動機式晤談被廣泛用來幫助戒菸，協助嘗試戒菸者探索和解決他們行為改變動機的不確定性，研究發現，動機式晤談較簡短詢問或一般常規護理，更能有效協助者戒菸(Lindson & Thompson,2015)，精神科病患抽菸比率高達70%至80%，明顯的高於一般族群，部分研究顯示，精神病患經過宣導與鼓勵參與戒菸計畫後，都能達到戒菸的目標（Chen, Ku, Lu, & Chou， 2002；Kelly & McCreadie，2000；McMillan，2009；Robson & Gray，2005)，但國內尚缺乏對動機式晤談及精神病人戒菸成效之相關研究。
目的：瞭解精神疾病患者及非精神疾病患者之吸菸行為動機，並比較其差異性，探討其接受二代戒菸衛教諮詢服務後，在吸菸行為動機、吸菸量及一氧化碳濃度影響之成效。
方法：本研究為一回溯性與前瞻性分析研究，係由南部某精神專科醫院戒菸門診於2013年1月至2014年6月期間就診之個案，剔除國際疾病分類號(ICD-9-CM)前三碼290-319，非思覺失調症、非情感性精神疾患者共15人，共收案235人，藉由戒菸個案管理資料的紀錄及病歷調查整理，比較精神疾患與非精神疾患戒菸者，接受戒菸門診之衛教諮詢服務成效差異。
結果：研究中發現，非精神疾病組接受戒菸衛教諮詢平均次數，少於思覺失調症組，且有顯著性( p =0.005**)；對於吸菸行為動機改善部分，僅思覺失調症組個案，在接受戒菸衛教諮詢一個月後，外在及內在因素多數皆有成效，且具有統計上顯著差異，非精神疾病組及情感性精神疾患組個案，則同樣僅在外在因素_菸情境、生活習慣、特定環境及交際應酬等四個項目有降低，且具有統計上顯著差異；吸菸量及一氧化碳濃度改變之成效上，則是所有疾病診斷群組，皆有成效，且具有統計上的顯著差異(p =0.000**)。
結論：本研究透過本主、客觀兩個效果指標，142位戒菸者在接受戒菸衛教諮詢介入一個月後，戒菸行為動機之外在因素_菸情境、生活習慣、特定環境及交際應酬等四個項目，在精神疾患與非精神疾患者均有成效，每日平均抽菸支數共少了17.41支菸，一氧化碳值（以下簡稱CO值）少了3.5ppm，且各疾病組間並無明顯差異，顯示運用動機式晤談提供衛教諮詢服務，可改善戒菸者的戒菸行為動機，並同時可讓抽菸數與一氧化碳值下降。

關鍵字

動機式晤談 ； 精神疾患 ； 戒菸

並列摘要

Introduction
The second generation of smoking cessation pilot program has been launched by Ministry of Health and Welfare since 2012. The smoking cessation health educator using motivational interviews theory, provide smoking cessation clinic cases health education advisory services. Motivational interviews are widely used to help smoking cessation, assisting smokers who try to explore and resolve their motivation to change behavior uncertainty. The study has found that relatively brief motivational interviews inquiries or general routine care, more effective smoking cessation facilitator (Lindson & Thompson, 2015). Psychiatric patients smoking rate up to 70-80% ,significantly higher than the general population, some studies have shown that mental illness through advocacy and encourage participation in smoking cessation plan after, to achieve the goal of smoking cessation（Chen, Ku, Lu, & Chou， 2002；Kelly & McCreadie，2000；McMillan，2009；Robson & Gray，2005), there is still a lack of research on the effectiveness of motivational interviews and psychiatric patients to quit smoking.
Purpose
The purpose of this study is to understand the Smoking behavior motivation among the general patients and psychiatric patients, and compare their differences, explore the smoking effectiveness and impact of the carbon monoxide concentration after receiving health education counseling services.
Method
This study is a retrospective and prospective analysis; subjects are the psychiatric out patient who received smoking cessation in outpatient department since Jan. 2013 to June 2014 in a psychiatric hospital in southern of Taiwan. Total of 235 subjects, data collation was the smoking cessation medical records and case management survey, comparison of mental disorders and mental disorders non smokers, the differences between the effectiveness of health education advisory services.
Result
The study found that non-psychiatric group received health education , the average number of smoking cessation counseling group was less than schizophrenia, and there is significant difference(p = 0.005 **) the schizophrenia groups of smoking behavior improvement is most effective after 1 month of smoking cessation health education counseling , and has a statistically significant difference, non-mental illness and affective mental disorders groups of cases are only in the external situation, habits, specific environmental and social entertainment four projects have lower, and has a statistically significant difference; the effect of smoking and change of carbon dioxide concentration, it is all diagnosis groups, there are results, and has a statistically significant difference.
Conclusion
Through this study, both subjective and objective performance metrics, 142 smokers has effectiveness in smoking situation, habit, specific environmental and social entertainment after received smoking cessation health education counseling intervention month. Total average daily countless smoke cigarettes 17.41, carbon monoxide value (hereinafter referred to as the CO value) 3.5ppm less. Using motivational interviews provide health education advisory services can improve smokers quit motives, and at the same time allowing smoke and carbon monoxide reduction.

並列關鍵字

Motivational interviewing ； Mental Illness ； Smoking cessation

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