Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review

Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and non-randomised controlled trials was undertaken. Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results

Las referencias bibliográficas sobre 'nursing diagnosis' en Medline (1994-2000)

Para conocer las características bibliométricas y metodológicas de los documentos sobre diagnósticos de enfermería indexados en la base Medline entre 1994 y 2000, se realizó un estudio en la Unidad de Salud Pública (Escuela Universitaria de Enfermería, Universitat de Barcelona) y en el Instituto Catalán de la Salud (Generalitat de Catalunya). Se empleó un diseño observacional, descriptivo y transversal. El material estudiado corresponde a 204 referencias bibliográficas (RB) que contenían los términos «nursing diagnosis» en el título e identificadas en la base Medline (1994-2000). Se concluye que la mayor parte de las RB estudiadas corresponde a artículos de tipo teórico; sus autores son del ámbito académico y desarrollan su actividad en el mundo anglosajón. Destaca el hecho de que en las RB estudiadas no constan algunas de las variables que se pretendían analizar en el presente estudio: filiación de los autores, lugar donde se realiza el estudio, número de sujetos estudiados, etcétera

La entrevista motivacional: una técnica útil en la consulta de enfermería

¿Alguna vez ha tenido la sensación de que su trabajo avanza menos de lo que el esfuerzo que le dedica se merece? Si a usted le ocurre lo que a mí, le invito a compartir algunas ideas

Política sanitària per infermeria, lideratge infermer i continuïtat de les cures a l'Atenció Primària

Màster en Administració i Gestió en Cures d'Infermeria de l'E.U. Santa Madrona, 2006, Director: José Tejad

Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial

Background: There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). Methods/Design: Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion: The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline

Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis

Background: Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS). Methods: Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction. Results: Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed. Conclusions: Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing

Las referencias bibliográficas sobre 'nursing diagnosis' en Medline (1994-2000)

Para conocer las características bibliométricas y metodológicas de los documentos sobre diagnósticos de enfermería indexados en la base Medline entre 1994 y 2000, se realizó un estudio en la Unidad de Salud Pública (Escuela Universitaria de Enfermería, Universitat de Barcelona) y en el Instituto Catalán de la Salud (Generalitat de Catalunya). Se empleó un diseño observacional, descriptivo y transversal. El material estudiado corresponde a 204 referencias bibliográficas (RB) que contenían los términos «nursing diagnosis» en el título e identificadas en la base Medline (1994-2000). Se concluye que la mayor parte de las RB estudiadas corresponde a artículos de tipo teórico; sus autores son del ámbito académico y desarrollan su actividad en el mundo anglosajón. Destaca el hecho de que en las RB estudiadas no constan algunas de las variables que se pretendían analizar en el presente estudio: filiación de los autores, lugar donde se realiza el estudio, número de sujetos estudiados, etcétera