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序 8 % 99 999 7.8.7.. 00 00 8,800,7 00 ~0 0000 ~8~. 戒菸共同照護網!! ARABC AAdvise Department of Health and Human Services, DHHS008Clinical Practice Guideline: Treating Tobacco Use and Dependence: 008 Update.009Quick Reference Guide for Clinicians 008 UpdateTreating Tobacco Use and Dependence. 0

目錄前言 :A's+ A (Ask) A (Adivse) A (Assess) A (Assist) A (Arrange) :A+A+A+B+B+A B B R's :C+C C C 7 8 9 0 0 8 8 9 0 9 8,800 00~0%898 999.8%%. ~% 9%0~0 0~0%0~0% 0 99,9009 9,9,8~ A's+R's

行為改變各階段處理原則行為改變階段臨床處理原則說明有意願戒菸者完成A s+加強介入提供戒菸諮詢及治療服務幫助個案戒菸現在沒有意願戒菸者 A+A+A+B+B+A 告知吸菸的壞處勸告戒菸並增強個案戒菸意願 C+C 透過稱讚鼓勵並協助處理戒菸個案遇到的困難預防再使用菸品剛戒菸者 A's 詢問 Ask, A 每次應診時需有系統地辨識所有吸菸者忠告 Advise, A 強烈敦促所有吸菸者戒菸評估 Assess, A 評估吸菸者之戒菸意願協助 Assist, A 提供病患戒菸協助安排 Arrange, A 安排追蹤確保後續個案戒菸管理增強動機的晤談 B 表達同理心找出落差與抗拒纏鬥強化自信恭喜及鼓勵 Congratulations, C 處理戒菸遇到的困難 Encounter, C 對每一位已戒菸者給予恭喜及鼓勵對有遇到困難者對症處理醫師時間戒菸效果男版分鐘護一生分鐘 -分鐘 0 戒菸服務的基本觀念及原則關聯性 Relevance 危險性 Risks 戒菸的好處 Rewards 戒菸的障礙 Roadblocks 反覆嘗試 Repetition R's增強動機的諮商內容 B 分鐘動機矛盾信心處理 -7倍戒菸困難與高危險情況處理倍依A s提供評估簡要勸告與支持病歷記載是否吸菸診間提供單張手冊海報倍倍資料來源 Litt J, et How to help your patients quit: practice based strategies for smoking cessation. Asia Pacific Family Medicine 00; : 7-9 7

. 戒菸服務的基本觀念及原則 ~ ~7 FDA Bupropion SRVarenicline. 0800- AskAdvise R's, -, 戒菸與其他心血管危險因子治療比較 ~ 8 9

各種醫療介入之成本分析 (LYS) (),87,88,00,9 7,000 9,7 0,000 >,000,000 > 0 mmhg,00,9,00 90~0 mmhg,08,800 > mg/dlcholestyramine,000 >,000,000 7,000 streptokinase,000 : Croghan IT, Offord KP, Evans RW, et al. Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clin Proc 997;7:97-. 0

. 戒菸治療服務臨床技巧 Primary prevention Relapse prevention Assist R's Ask Advise Assess Arrange follow up Assist 8FTND 0 一有意願戒菸者完成 A's + 加強介入 A's A (Ask) (Blood Pressure, BP) (Pulse, P) (Weight) BMI (Temperature, T) (Respiratory Rate, R) A (Advise) A A A A A 7,000 A A Vital signs tobacco use, Sep 00, CDC. Available at: http://www.cdc.gov/vitalsigns/tobaccouse/smoking/risk.html

Lung Cancers Head or Neck Leukemia Kidney Stomach Pancreas Colon Bladder Cervix Chronic Diseases Stroke Blindness Gum infection Aortic rupture Heart disease Pneumonia Chronic lung disease & asthma Hardening of the arteries Reduced fertility Hip fracture Vital signs tobacco use, Sep 00, CDC. Available at: http://www.cdc.gov/vitalsigns/tobaccouse/smoking/risk.html A (Assess) A (Assist) (STAR) A A S (set) T (tell) A (anticipate) R (remove) 8 FTND0 Bupropion SRVarenicline

abstinence ~ 0 8 0 0 - http://www.health99.doh.gov.tw/ 0800-0800- 0-7- http://www.bhp.doh.gov.tw/bhpnet/portal/ http://tobacco.bhp.doh.gov.tw/ http://www.health99.doh.gov.tw/ http://www.tsh.org.tw/ http://www.e-quit.org/ 7

A(Arrange) A 加強介入.. ~~ 80~00 70~90..0800-. (Assessment) (Program clinicians) (Program intensity) (Program format (Type of counseling and behavioral therapies) (Medication) (population) Fagerström 0 problem solving( skilltraininga(assist)- A(Assist)- Bupropion SRVarenicline 8 9

現行用於治療尼古丁依賴的第一線藥物 // 0 (FTND)~ mgftnd7 mg0 9 ~7~9-0~~8 / 8 0~0 7~80() 0

0 BupropionVarenicilineBupropion Varenicline /0 Bupropion 8~ 8 酶酶 0.mg~ 7 Varenicline 0.mg8mg

二現在沒有意願戒菸者 A+A+A+B+B+A A A A B A A A B B A B 0800-

B R's R s Relevance Risks B () ( ) ( ) R s Roadblocks Repetition A Rewards 7

三剛戒菸者 C+C C C A A C C C C C 8 A 9 0800- C ) ) ) ) cortisol ) ~

. 有效的戒菸方法 A randomized clinical trials B A A B A A 0 8-0 0-0

A randomized clinical trials B A A A B 0800-0900~00 ( ) 0800--- http://www.health99.doh. gov.tw/ + B A A A(Assist)- A (Assist)- Fiore MC et.al: Treating Tobacco Use and Dependence:008 update. Clinical Practice Guideline. U.S. Department of Health and Human Services (USDHHS). Public Health Service, 008.

戒菸藥物療效比較之後設分析 (meta-analysis) > + 9%. 8.. Varenicline mg/ > Varenicline mg/ Bupropion SR.8.9 7.8.9.7..9...89..... >.7.0....8 9.0..9.8 Fiore MC et.al: Treating Tobacco Use and Dependence:008 update. Clinical Practice Guideline. U.S. Department of Health and Human Services (USDHHS). Public Health Service, 008.

. 特殊族群戒菸治療服務. adviceassistance arrange adviceassistance 8 9%.7.7.-7. FDA D Bupropion B A(Assist)- 9% 7..9.0-9. 9% 8..00.-. 7

< Fagerström < 0 DHHS (Department of Health and Human Services, DHHS)008 Treating Tobacco Use and Dependence: 008 Update. Clinical Practice Guideline. 8 9

. 臨床治療常見的 Q 什麼樣的個案需要使用戒菸藥物? A 8 Fagerström0 Q 使用戒菸藥物戒菸會很貴嗎? A 0800- http://www.health99.doh.gov.tw/ Q 戒菸藥物會產生什麼樣的副作用? A 尼古丁替代藥物 NRT 非尼古丁替代藥物 Bupropion 酶 MAOIs Varenicline 0

Q 臨床上常見, 個案不願意戒菸的藉口? A C / Q 性別, 會影響戒菸藥物的療效? 7,00070 0 A Bupropion SRVarenicline Q 對於尼古丁高度成癮者, 建議的戒菸藥物使用方式為何? A + Bupropion SR+ FDA+ Bupropion SR Q7 過去有心血管疾病患者, 是否也可以使用尼古丁戒菸藥物? A7

Q8 如果不小心再次吸菸, 怎麼辦? A8 A Arrange Q9 如果個案只想要領取戒菸藥物, 不願意接受戒菸諮詢或衛教? A9 p r o b l e m solvingskill-trainingaassist- AAssist- ( problem solvingskill-trainingaassist- A(Assist)-

. 常用戒菸資源 http://www.health99.doh.gov.tw/ 0800- (0)-08 http://www.klchb.gov.tw/ (0)70-8889 http://www.health.gov.tw/ (0)7-7 http://www.health.ntpc.gov.tw/ (0)-09 http://www.tychb.gov.tw/ (0)7- http://dep.hcchb.gov.tw/ (0)-80 http://www.hcshb.gov.tw/ (07)-79 http://www.mlshb.gov.tw/ (0)-9 http://www.health.taichung.gov.tw/ (0)7- http://www.chshb.gov.tw/ (09)-7 http://www.ntshb.gov.tw/ (0)7-88 http://www.ylshb.gov.tw/ (0)-80 http://www.cichb.gov.tw/ (0)-000 http://www.cyshb.gov.tw/ (0)7-97 (0)-77 http://www.tnchb.gov.tw/ (07)7-000 (07)7-87 (07)-7 http://khd.kcg.gov.tw/ (08)78-7 http://www.ptshb.gov.tw/ (089)-7 http://www.ttshb.gov.tw/ (0)8-7 http://www.hlshb.gov.tw/ (0)9- http://www.ilshb.gov.tw/ (0)97- http://www.phchb.gov.tw/ (08)0-97 http://www.kmhb.gov.tw/ (08)09 http://www.matsuhb.gov.tw/ 0800-0-7-0--00 http://www.bhp.doh.gov.tw/bhpnet/portal/ http://tobacco.bhp.doh.gov.tw/ http://www.health99.doh.gov.tw/ http://www.tsh.org.tw/ http://ttc.bhp.doh.gov.tw/quit/ http://www.tma.tw/index.asp http://www.tafm.org.tw/ http://www.nurse.org.tw/ http://www.twna.org.tw/ http://www.taiwan-pharma.org.tw/# http://www.e-quit.org/. Fiore MC et.al: Treating Tobacco Use and Dependence:008 update. Clinical Practice Guideline. U.S. Department of Health and Human Services (USDHHS). Public Health Service, 008.. Fiore MC et.al: Quick Reference Guide for Clinicians. Treating Tobacco Use and Dependence. U.S. Department of Health and Human Services (USDHHS). Public Health Service, 009.. Litt J, ethow to help your patients quit: practice based strategies for smoking cessation.asia Pacific Family Medicine 00; : 7-9. Croghan IT, Offord KP, Evans RW, et al. Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clin Proc 997;7:97-.. Vital signs- tobacco use, Sep 00, CDC. Available at: http://www.cdc.gov/vitalsigns/tobaccouse/smoking/risk. html. Wen CP, Tsai SP, Chen CJ et al. Smoking attributable mortality for Taiwan and its projection to 00 under different smoking scenarios. Tobacco Control 00:. 7. 8., 00 7

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