第六章 結論與建議
第二節 建議
1. 目前醫院之門診戒菸服務仍侷限於民眾有戒菸意願時，走入門診接受 戒菸服務，但仍有許多民眾對於戒菸藥物與戒菸補助並不全然了解。
主動戒菸服務深入社區與職場的型式是可以大大增加吸菸者嘗試戒菸 的機會，但也需要有醫院及衛生機關政策的支持。因此，未來可考慮 以預防醫學研究的觀點，進行這方面政策成本效益之研究。
2. 職場戒菸服務因目前並無有效推廣，造成研究樣本數較少，其原因是 職場大多不知可與醫院合作提供此項戒菸服務，但醫院也需評估人力 與物力後，才能決定是否提供此項服務。未來如果能有政策鼓勵職場 與醫療院所合作，多多開辦職場的戒菸行動門診，勸導吸菸員工接受 戒菸服務，降低職場吸菸率，則可有更多研究討論職場戒菸服務成效。
3. 戒菸服務除了本研究討論的四種型式外，另外還有例如住院戒菸的服 務，但因研究醫院人力的關係，此項戒菸服務尚無法有效推廣，未來 的研究也可將此項戒菸服務模式納入研究。
參考文獻
（4），177-188。doi: 10.3966/168232812013122304003
邱淑媞、郭斐然、溫啟邦（2012）。全人照護與關懷--醫療安全暨品質研
doi: 10.6288/tjph2008-27-01-05
陳麗如（2008）。菸品健康福利捐對目前吸菸者之戒菸想法及吸菸行為 變化之影響探討-以台北市萬華區為例 （未出版之碩士論文）。臺 北醫學大學護理學系，台北市。
職場戒菸衛教對吸菸行爲之影響 。中華職業醫學雜誌，14（3），
269-280。doi: 10.30027/CJOM.200710.0006
劉瑞瑤、陳曾基、黃信彰（2017）。門診戒菸成功之影響因子探討。台 灣家庭醫學雜誌，27（3），146-153。
doi: 10.3966/168232812017092703002
衛生福利部國民健康署（2014）。世界衛生組織評估報告：菸價是降低 吸菸率最有效策略。取自 https://www.mohw.gov.tw/cp-3199-22290-1.html
二、英文部分
Bacha, Z. A., Layoun, N., Khayat, G., & Allit, S. (2018). Factors associated with smoking cessation success in Lebanon. Pharm Pract (Granada), 16(1), 1111. doi:10.18549/PharmPract.2018.01.1111
Baker, T. B., Piper, M. E., Stein, J. H., Smith, S. S., Bolt, D. M., Fraser, D. L.,
& Fiore, M. C. (2016). Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation at 26 Weeks: A Randomized Clinical Trial. Journal of the American Medical Association, 315(4), 371-379. doi:10.1001/jama.2015.19284 Chabrol, H., Niezborala, M., Chastan, E., & de Leon, J. (2005). Comparison
of the Heavy Smoking Index and of the Fagerstrom Test for Nicotine Dependence in a sample of 749 cigarette smokers. Addict Behav, 30(7), 1474-1477. doi:10.1016/j.addbeh.2005.02.001
Chang, F. C., Hu, T. W., Lin, M., Yu, P. T., & Chao, K. Y. (2008). Effects of financing smoking cessation outpatient services in Taiwan. Tobacco Control, 17(3), 183-189. doi:10.1136/tc.2007.021907
Chang, F. C., Hu, T. W., Lo, S. Y., Yu, P. T., Chao, K. Y., & Hsiao, M. L.
(2010). Quit smoking advice from health professionals in Taiwan: the role of funding policy and smoker socioeconomic status. Tobacco Control, 19(1), 44-49. doi:10.1136/tc.2009.031435
Chang, F. C., Sung, H. Y., Zhu, S. H., Feng, T. Y., & Chiou, S. T. (2017).
Effects of Smoking Cessation Media and Community Campaigns in Taiwan. American Journal of Health Promotion, 31(1), 43-51.
doi:10.4278/ajhp.140922-QUAN-457
Chang, P. Y., Lo, P. C., Chang, H. C., Hsueh, K. C., & Tsai, Y. W. (2016).
Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan. PLoS One, 11(11), e0166992. doi:10.1371/journal.pone.0166992
Chang, P. Y., Shiu, M. N., Yuan, Y. T., Chang, H. C., Su, P. Y., & Lan, T. H.
(2019). Comparative Effectiveness of Varenicline and Nicotine Replacement Therapy for Smoking Cessation in Older and Younger Smokers: A Prospective Cohort in Taiwan. Nicotine & Tobacco Research, 21(2), 149-155. doi:10.1093/ntr/ntx275
Chen, P. C., Lee, Y. C., Tsai, S. T., & Lai, C. K. (2012). A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint. Nicotine & Tobacco Research, 14(5), 522-530.
doi:10.1093/ntr/ntr241
Chung, Y. H., Chang, H. H., Lu, C. W., Huang, K. C., & Guo, F. R. (2018).
Addition of one session with a specialist counselor did not increase efficacy of a family physician-led smoking cessation program. The Journal of International Medical Research, 46(9), 3809-3818.
doi:10.1177/0300060518780151
Curry, S. J., Grothaus, L. C., McAfee, T., & Pabiniak, C. (1998). Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. The New England Journal of Medicine, 339(10), 673-679. doi:10.1056/nejm199809033391006 Dockrell, M. (2017). Models of delivery for stop smoking services: options
and evidence. Retrieved from
https://www.gov.uk/government/publications/stop-smoking-services-models-of-delivery
Eisenberg, M. J., Filion, K. B., Yavin, D., Belisle, P., Mottillo, S., Joseph, L.,… Pilote, L. (2008). Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. Canadian Medical Association journal, 179(2), 135-144. doi:10.1503/cmaj.070256 Foulds, J., Gandhi, K. K., Steinberg, M. B., Richardson, D. L., Williams, J.
M., Burke, M. V., & Rhoads, G. G. (2006). Factors associated with quitting smoking at a tobacco dependence treatment clinic. American Journal of Health Behavior, 30(4), 400-412.
doi:10.5555/ajhb.2006.30.4.400
Fu, S. S., van Ryn, M., Nelson, D., Burgess, D. J., Thomas, J. L., Saul, J.,…Joseph, A. M. (2016). Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for
socioeconomically disadvantaged smokers: a randomised clinical trial.
Thorax, 71(5), 446-453. doi:10.1136/thoraxjnl-2015-207904 Fu, S. S., van Ryn, M., Sherman, S. E., Burgess, D. J., Noorbaloochi, S.,
Clothier, B.,…Joseph, A. M. (2014). Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial.
Journal of the American Medicine Association Internal Medicine, 174(5), 671-677. doi:10.1001/jamainternmed.2014.177
Goldstein, A. O., Gans, S. P., Ripley-Moffitt, C., Kotsen, C., & Bars, M.
(2018). Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings. Chest, 153(2), 554-562.
doi:10.1016/j.chest.2017.11.002
Haas, J. S., Linder, J. A., Park, E. R., Gonzalez, I., Rigotti, N. A., Klinger, E.
V.,…Williams, D. R. (2015). Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial.
Journal of the American Medicine Association Internal Medicine, 175(2), 218-226. doi:10.1001/jamainternmed.2014.6674
Hagimoto, A., Nakamura, M., Morita, T., Masui, S., & Oshima, A. (2010).
Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study. Addiction, 105(1), 164-173. doi:10.1111/j.1360-0443.2009.02735.x
Hausherr, Y., Quinto, C., Grize, L., Schindler, C., & Probst-Hensch, N.
(2017). Smoking cessation in workplace settings: quit rates and
determinants in a group behaviour therapy programme. Swiss Medical Weekly, 147, w14500. doi:10.4414/smw.2017.14500
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O.
(1991). The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86(9), 1119-1127.
Ho, K. S., Choi, B. W., Chan, H. C., & Ching, K. W. (2016). Evaluation of biological, psychosocial, and interventional predictors for success of a smoking cessation programme in Hong Kong. Hong Kong Medical Journal, 22(2), 158-164. doi:10.12809/hkmj154549
Hopkins, D. P., Briss, P. A., Ricard, C. J., Husten, C. G., Carande-Kulis, V. G., Fielding, J. E.,…Harris, K. W. (2001). Reviews of evidence regarding
interventions to reduce tobacco use and exposure to environmental tobacco smoke. American of Journal Preventive Medicine, 20(2 Suppl), 16-66.
Hsueh, K. C., Chen, C. Y., Yang, Y. H., & Huang, C. L. (2010). Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: a longitudinal evaluation. Evaluation & The Health
Professions, 33(1), 12-25. doi:10.1177/0163278709356185
Hsueh, K. C., Hsueh, S. C., Chou, M. Y., Pan, L. F., Tu, M. S., McEwen, A.,
& West, R. (2014). Varenicline versus transdermal nicotine patch: a 3-year follow-up in a smoking cessation clinic in Taiwan.
Psychopharmacology (Berl), 231(14), 2819-2823. doi:10.1007/s00213-014-3482-9
Huang, W. H., Hsu, H. Y., Chang, B. C., & Chang, F. C. (2018). Factors Correlated with Success Rate of Outpatient Smoking Cessation Services in Taiwan. International Journal of Environ Research and Public Health, 15(6). doi:10.3390/ijerph15061218
Hughes, M. C., Yette, E. M., Hannon, P. A., Harris, J. R., Tran, N. M., & Reid, T. R. (2011). Promoting tobacco cessation via the workplace:
opportunities for improvement. Tobacco Control, 20(4), 305-308.
doi:10.1136/tc.2010.041038
Kaper, J., Wagena, E. J., Willemsen, M. C., & van Schayck, C. P. (2005).
Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trial. Addiction, 100(7), 1012-1020. doi:10.1111/j.1360-0443.2005.01097.x
Kapusta, N. D., Pietschnig, J., Plener, P. L., Blüml, V., Lesch, O. M., &
Walter, H. (2010). Does Breath Carbon Monoxide Measure Nicotine Dependence? Journal of Addictive Diseases, 29(4), 493-499.
doi:10.1080/10550887.2010.509280
Kottke, T. E., Battista, R. N., DeFriese, G. H., & Brekke, M. L. (1988).
Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. Journal of the American Medical Association, 259(19), 2883-2889.
Laniado-Laborin, R. (2010). Smoking cessation intervention: an evidence-based approach. Postgraduate Medicine, 122(2), 74-82.
doi:10.3810/pgm.2010.03.2124
Lee, C. W., & Kahende, J. (2007). Factors associated with successful smoking cessation in the United States, 2000. American Journal of Public Health, 97(8), 1503-1509. doi:10.2105/ajph.2005.083527
Lee, S., Tsai, Y. W., & Sung, H. Y. (2016). Smoking cessation and receipt of cessation advice from health professionals among older smokers in Taiwan. Preventive Medicine, 91, 89-95.
doi:10.1016/j.ypmed.2016.08.002
Li, L., Borland, R., Yong, H. H., Fong, G. T., Bansal-Travers, M., Quah, A.
C.,…Fotuhi, O. (2010). Predictors of smoking cessation among adult smokers in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia Survey. Nicotine & Tobacco Research, 12 Suppl, S34-44. doi:10.1093/ntr/ntq030
Lo, W. C., Ku, C. C., Chiou, S. T., Chan, C. C., Chen, C. L., Lai, M. S., &
Lin, H. H. (2017). Adult mortality of diseases and injuries attributable to selected metabolic, lifestyle, environmental, and infectious risk factors in Taiwan: a comparative risk assessment. Population Health Metrics, 15, 17. doi:10.1186/s12963-017-0134-4
Messer, K., Trinidad, D. R., Al-Delaimy, W. K., & Pierce, J. P. (2008).
Smoking cessation rates in the United States: a comparison of young adult and older smokers. American Journal of Public Health, 98(2), 317-322. doi:10.2105/ajph.2007.112060
Moher, M., Hey, K., & Lancaster, T. (2005). Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews, (2), Cd003440. doi:10.1002/14651858.CD003440.pub2
Montagna, R. A., & Hupcey, J. E. (2000). Increasing smoking cessation counseling by advanced practice nurses. Clinical Excellence for Nurse Practitioners: The international journal of NPACE, 4(4), 224-230.
Pena, P., Zagolin, M., Acuna, M., Navarrete, S., Bustamante, P., & Canals, A.
(2016). Factors associated with success of a smoking cessation program. Revista Medica de Chile, 144(8), 965-971.
doi:10.4067/s0034-98872016000800002
Perkins, K. A., Levine, M. D., Marcus, M. D., & Shiffman, S. (1997).
Addressing women's concerns about weight gain due to smoking cessation. Journal of Substance Abuse Treatment, 14(2), 173-182.
Rigotti, N. A., Munafo, M. R., & Stead, L. F. (2008). Smoking cessation
interventions for hospitalized smokers: A systematic review. Archives of Internal Medicine, 168(18), 1950-1960.
doi:10.1001/archinte.168.18.1950
Shyu, K. G., Wu, C. J., Mar, G. Y., Hou, J. Y. C., Li, A. H., Wen, M. S.,…
Chiang, F. T. (2011). Clinical Characteristics, Management and In-Hospital Outcomes of Patients with Acute Coronary Syndrome Observations from the Taiwan ACS Full Spectrum Registry. Acta Cardiologica Sinica, 27, 135-144.
The Tobacco Atlas. (2019). Featured Topic. Retrieved from https://tobaccoatlas.org/
Tzelepis, F., Paul, C. L., Walsh, R. A., McElduff, P., & Knight, J. (2011).
Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality. Journal of National Cancer Institute, 103(12), 922-941. doi:10.1093/jnci/djr169
Vogt, F., Hall, S., & Marteau, T. M. (2005). General practitioners' and family physicians' negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction, 100(10), 1423-1431. doi:10.1111/j.1360-0443.2005.01221.x
Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D.
A.,…Audrain-McGovern, J. (2009). A randomized, controlled trial of financial incentives for smoking cessation. The New England Journal of Medicine, 360(7), 699-709. doi:10.1056/NEJMsa0806819
WHO. (2017). Noncommunicable Diseases Progress Monitor 2017.
Retrieved from http://www.who.int/nmh/publications/ncd-progress-monitor-2017/en/
WHO. (2018). Tobacco Free Initiative. Retrieved from
http://www.who.int/tobacco/quitting/summary_data/en/
WHO. (2019). Tobacco. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tobacco
Wong, S. L., Shields, M., Leatherdale, S., Malaison, E., & Hammond, D.
(2012). Assessment of validity of self-reported smoking status. Health Reports, 23(1), 47-53.
Wu, P. C., Hsueh, K. C., Mar, G. Y., Hsueh, S. C., Tu, M. S., McRobbie, H., &
Hajek, P. (2016). Gender Differences in Outcome of an Attempt to Stop Smoking Among Smokers Attending a Smoking Cessation Clinic in Taiwan: 3-Year Follow-Up Study. Evaluation & The Health
Professions, 39(3), 317-325. doi:10.1177/0163278715616439
Wu, T. Y., Hung, L. Y., Chie, W. C., Chiu, T. Y., & Guo, F. R. (2016). Change of government's subsidization policy improves smoking cessation services: a cross-sectional study from the perspectives of physicians.
BioMed Central Public Health, 16, 415. doi:10.1186/s12889-016-3052-7
附錄一、「醫療院所戒菸服務補助計畫」個案紀錄表
附錄二、戒菸衛教暨個案管理紀錄表
附錄三、戒菸活動照片
醫師戒菸活動演講 醫師戒菸活動看診
戒菸活動一氧化碳檢測 戒菸活動戒菸衛教