병원기반 금연중재프로그램 참여 정도에 따른 급성 심근경색증환자의 퇴원 후 12개월 금연 성공률
Continuous Abstinence Rates from Smoking Over 12 Months according to the Frequency of Participation in a Hospital-based Smoking Cessation Program among Patients Discharged after Acute Myocardial Infarction
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연구배경: 본 연구는 일개 대학병원의 심근경색증 환자를대상으로 병원기반 금연중재프로그램을 시행하고 퇴원 후12개월까지의 지속 금연율에 미치는 효과를 평가하였다. 방법: 본 연구는 2012년 7월부터 2013년 12월에 급성 심근경색증으로 입원한 환자 중 퇴원 후 12개월까지 금연 지속 여부를 확인 가능한 98명을 분석 대상으로 하였다. 금연중재프로그램은 면대면 중재 총 6회(입원 1회, 퇴원 후 외래 5회)를 시행하였다. 금연 성공 여부는 호기 일산화탄소측정을 통해 농도가 6 ppm 이하로 나오면 금연을 하고 있는 것으로 판단하였다. 결과: 금연중재프로그램에 참여한 전체 환자의 평균 연령은 55.2±10.8세였으며, 지속 금연율은 1개월 63.3%, 3개월 49.0%, 6개월 43.9%, 12개월 37.8%였다. 12개월 기간동안 정해진 6회의 금연중재에 모두 참여한 환자들의 12개월 지속 금연율은 69.7%로 5회 이하 참여한 환자들의 지속금연율인 21.5%에 비해 유의하게 높았다(Ps＜0.001). 일반적 특성 및 금연관련 특성을 보정한 로지스틱 회귀분석 결과, 5회 이하 참여한 경우에 비해 6회 모두 참여한 경우(OR: 7.96, 95% CI: 2.07-30.55)에서 12개월까지의 지속 금연율이 유의하게 증가하였다. 결론: 심근경색증으로 입원한 흡연자에서 병원기반 금연중재프로그램의 지속적 참여가 퇴원 후 12개월까지의 금연성공률을 유의하게 향상시켰다. 교육과 상담으로 구성된 병원기반 금연중재프로그램이 심근경색증 환자 관리의 중요한 요소로 포함되어야 할 것이다.
Abstract
Background: This study evaluated the continuous abstinence rates from smoking at 12-month after a hospital- based smoking cessation program was applied for smokers hospitalized for acute myocardial infarction. Methods: Among those who are hospitalized for acute myocardial infarction from January 2012 to December 2013, ninety-eight smokers agreed to quit smoking were eligible for follow up to 12 months. Each of them underwent six consecutive sessions (first during admission, the other 5 sessions after discharge) of behavioral modification, counseling for withdrawal symptoms, and anti-smoking advices by a trained nurse. Exhaled carbon monoxide measurements less than 6 ppm were used to confirm the smoking cessation status of each participant. Results: Mean age of all participants was 55.2±10.8 years old, and their continuous abstinence rates at 1, 3, 6, 12 months were 63.3%, 49.0%, 43.9%, and 37.8% for each. The continuous abstinence rate from smoking after 12 months was 69.7% and significantly higher in those who completed the 6 sessions than 21.5% in those who completed 5 sessions or less (P＜0.001). After adjustment for general and smoking-related characteristics, multivariate logistic regression analysis revealed that full participation relative to 5 or less participation was significantly associated with higher continuous abstinence rate from smoking at 12 months (odds ratio: 7.96; 95% confidence interval: 2.07-30.55). Conclusions: The consistency of participating in a hospital-based smoking cessation program, described herein, significantly improved success rates of smoking cessation in patients discharged after acute myocardial infarction. Hospital-based smoking cessation program based on education and counseling should be included as an important part of patient management for acute myocardial infarction.
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