scholarly journals Stopping smoking advice given by practice assistants after routine cervical screening in general practice: a qualitative exploration of potential barriers and enablers.

2019 ◽  
Author(s):  
Marthe B.L. Mansour ◽  
Matty R. Crone ◽  
Henk C. van Weert ◽  
Niels H. Chavannes ◽  
Kristel M. van Asselt
Keyword(s):  
General Practice ◽  
Smoking Cessation ◽  
General Practitioners ◽  
Smoking Status ◽  
Cervical Screening ◽  
Behavioural Change ◽  
Young Female ◽  
Influential Factors ◽  
Individual Level ◽  
Potential Barriers

Abstract Background Cervical screening could be an appropriate moment to provide female smokers with stopping smoking advice and support. In Dutch general practice cervical smears are performed by practice assistants. The aim of this study was to identify potential barriers or enablers for a stopping smoking strategy performed by trained practice assistants after routine cervical screening. The strategy consists of brief stopping smoking advice and is based on the Ask-Advise-Connect approach.Methods Three focus group meetings were held with 10 practice assistants, 3 nurses, and 6 general practitioners. We analysed data using thematic analysis. Identified factors are presented within the framework of the Social Ecological Model.Results Potential influential factors were identified at individual, interpersonal, and workplace levels. At the individual level: practice assistants did not see themselves as having a professional role in a smoking cessation program. While they could register smoking status, they were reluctant to provide advice. However, practice assistants valued having advice at hand in order to make relatively young female smokers aware of the health risks At the interpersonal level: practice assistants thought that their relationship with the women would change if they gave stopping smoking advice. Moreover, the assistant’s own attitude to smokers and her beliefs about the smoker’s willingness to change behaviour could influence the relationship. At the workplace level: the availability and motivation of nurses might hamper referral. The general practitioners’ opinion about primary prevention and smoking cessation could influence the amount of support given to practice assistants when it comes to providing stopping smoking advice.Conclusions At individual, interpersonal, and workplace levels, several factors could influence the provision of a stop smoking strategy by a practice assistant. These factors could be used to design a behavioural change intervention to be provided by practice assistants after cervical cancer screening.

Smoking cessation interventions in pregnancy: practice and views of midwives, GPs and obstetricians

1995 ◽  
Vol 54 (2) ◽  
pp. 150-162 ◽  
Author(s):  
Paul Clasper ◽  
Martin White
Keyword(s):  
Smoking Cessation ◽  
Pregnant Women ◽  
General Practitioners ◽  
Questionnaire Survey ◽  
Smoking Status ◽  
Smoking Cessation Counselling ◽  
Pregnant Smokers ◽  
Level Of Training ◽  
Experienced Difficulty ◽  
In Pregnancy

A questionnaire survey of general practitioners, midwives and obstetricians was carried out in 1992 in order to measure the delivery of, and attitudes towards, smoking cessation interventions in pregnancy. Most professionals were found to ask about the smoking status of pregnant women, record smoking status and explain the risks of smoking while pregnant. Fewer professionals gave pregnant smokers advice on how to stop or monitored and reviewed smoking status throughout pregnancy. Most experienced difficulty and a lack of enjoyment while giving smoking cessation counselling. Over half (53%) perceived themselves to be insufficiently trained, whilst few (28%) thought that they possessed the necessary skills. There is therefore a need to increase the coverage and frequency of smoking cessation counselling and to increase the level of training and skills among professionals.

Prevalence and characteristics associated with concurrent smoking and alcohol misuse within Australian general practice patients

2020 ◽  
Vol 44 (1) ◽  
pp. 125
Author(s):  
Breanne Hobden ◽  
Jamie Bryant ◽  
Kristy Forshaw ◽  
Christopher Oldmeadow ◽  
Tiffany-Jane Evans ◽  
...  
Keyword(s):  
General Practice ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
General Practitioners ◽  
Alcohol Misuse ◽  
Smoking Status ◽  
Demographic Characteristics ◽  
International Studies ◽  
Australian General Practice ◽  
Different Levels

Objectives This study sought to determine, among a large sample of Australian general practice patients: (1) the prevalence of smoking among different levels of alcohol misuse; and (2) whether the associations between demographic characteristics and alcohol use differ according to smoking status. Methods A cross-sectional survey was administered from 2010 to 2011 to 3559 patients from 12 Australian urban general practices. Patients reported their demographic details, smoking status and their alcohol intake. Results The overall prevalence of reported concurrent smoking and alcohol misuse was 7.8%. Smokers were 3.81-fold more likely to have a higher level of alcohol consumption than non-smokers (95% confidence interval 3.13–4.63; P<0.0001). There was evidence that smoking was an effect modifier of the relationship between alcohol misuse and chronic illness. Conclusions There was an increasing prevalence of smoking with increasing level of alcohol consumption. In addition, those with chronic conditions who smoked had greater odds of higher levels of alcohol consumption. Preventative interventions for these substances are needed to reduce the burden associated with concurrent smoking and alcohol misuse. What is known about the topic? Tobacco and alcohol are the most commonly used substances and contribute to over 10million deaths annually. The risk of disease is high when using either of these substances, however, concurrent use is associated with a greatly compounded risk. Australian data is limited regarding the prevalence of concurrent tobacco and alcohol misuse, however, international studies suggest variation in prevalence rates between different clinical settings. What does this paper add? This study examined the prevalence of concurrent smoking and alcohol misuse among different levels of alcohol misuse severity within an Australian general practice setting. Additionally it explored whether the associations between demographic characteristics and alcohol use differ according to smoking status. What are the implications for practitioners? This study has important implications for disease prevention and the delivery of preventive health services by general practitioners. Considering one in 100 clinical treatments provided in general practice relate to preventative smoking or alcohol counselling, it is critical that efforts are made to ascertain risk factors such as smoking and alcohol misuse to increase treatment rates. General practitioners should consider screening for smoking and alcohol misuse opportunistically during routine clinical encounters, as well as screening for smoking or alcohol misuse if one or the other is present.

scholarly journals Smoking cessation and the general practice pharmacist

2019 ◽  
Vol 14 (3) ◽  
pp. 186-189
Author(s):  
Louise S Deeks ◽  
Sam Kosari ◽  
Anne Develin ◽  
Gregory M. Peterson ◽  
Mark Naunton
Keyword(s):  
Carbon Monoxide ◽  
General Practice ◽  
Smoking Cessation ◽  
Smoking Status ◽  
Randomised Trial ◽  
Community Pharmacists ◽  
Median Number ◽  
Abstinence Rate ◽  
Quit Attempts ◽  
Smoking Cessation Services

AbstractIntroductionRoles for pharmacists in general practice are developing in Australia. It is known that pharmacists can provide effective smoking cessation services in other settings but evidence in general practice is lacking.AimTo determine whether a pharmacist can provide effective smoking cessation services within general practice.MethodData from smoking cessation consultations were obtained for 66 consecutive patients seen by one practice pharmacist. The pharmacist tailored interventions to the individual. Medication was offered in collaboration with community pharmacists and general practitioners. Quit coaching, based on motivational interviewing, was conducted. Smoking status was ascertained at least 6 months after the intended quit date and verified by a carbon monoxide breath test where possible.ResultsThe patients’ median age was 43 years (range 19–74 years); 42 were females (64%). At baseline, the median (i) number of pack years smoked was 20 (range: 1–75); (ii) Fagerstrom Test of dependence score was 6 (1–10); and (iii) number of previous quit attempts was 3 (0–10). Follow-up after at least 6 months determined a self-reported point prevalence abstinence rate of 30% (20/66). Of all patients who reported to be abstinent, 65% (13/20) were tested for carbon monoxide breath levels and were all below 7 ppm. The biochemically verified smoking abstinence rate was therefore 20% overall (13/66). Successful quit attempts were associated with varenicline recommendation (69% v 25%), increased median number of practice pharmacist consultations (4 v 2 per patient) and mental health diagnosis (85% v 51%).ConclusionOur observed abstinence rate was comparable or better than those obtained by practice nurses, community pharmacists and outpatient pharmacists, indicating the general practice pharmacist provided an effective smoking cessation intervention. A larger randomised trial is warranted.

Costs and Remuneration for Cervical Screening in General Practice in the West of Scotland

1996 ◽  
Vol 1 (4) ◽  
pp. 217-223 ◽  
Author(s):  
Susan Myles ◽  
Sally Wyke ◽  
Tracy Ibbotson ◽  
Sally Macintyre ◽  
Jim McEwen ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
General Practitioners ◽  
Cervical Screening ◽  
Sensitivity Analyses ◽  
The West ◽  
Skill Mix ◽  
Primary Health ◽  
Deprived Areas

Objectives: To investigate associations between costs and remuneration for cervical screening in general practice in relation to skill mix, features of practice structure and deprivation levels in the local area; and, to identify efficient policies for organising cervical screening in general practice. Method: Questionnaire survey and interview study in 87 general practices in Greater Glasgow Health Board an area in the west of Scotland which covers a socio-economically varied population. The main outcome measures were remuneration to cost ratios (RCRs) for cervical screening and their natural logarithms (logRCRs). Results: Both the costs of cervical screening and RCRs varied widely between the 87 practices taking part. RCRs ranged from 0.29 to 14.67 (mean 2.64, median 2.18, interquartile range 1.15–2.98). Twenty-one per cent (18) of practices earned less than they spent on the organisation of screening, whilst 9% (8) of practices had RCRs of more than 5:1. RCRs were significantly lower if medical staff were involved in either taking smears or dealing with results. RCRs did not vary by social deprivation score, despite uptake being lower in practices in more deprived areas. This was explained by nurses working in practices in deprived areas being more likely to take smears than nurses working in more affluent areas. Sensitivity analyses were undertaken, altering key time and cost assumptions. As a result, the absolute values of the RCRs changed, although the overall pattern of association did not, with the exception of doctor involvement in processing results which was no longer significant when average general practitioners’ income was substituted for locum rates. Conclusions: Practices in deprived areas may be responding to greater pressure of work by making optimal use of skill mix within the primary health care team. A more graduated incentive payment scheme may more fairly reward practices in deprived areas which are less likely to achieve 80% uptake due to relatively intractable features of practice structure. Assuming that practice nurses provide an equivalent quality of service to that provided by general practitioners, results suggest that doctor-nurse substitution would be cost-effective for general practice based cervical screening. Resource savings (principally doctor's time) could be redeployed to other areas of primary health care.

scholarly journals Stopping smoking advice given by practice assistants after routine cervical screening in general practice: a qualitative exploration of potential barriers and enablers.

2020 ◽  
Author(s):  
Marthe B.L. Mansour ◽  
Matty R. Crone ◽  
Henk C. van Weert ◽  
Niels H. Chavannes ◽  
Kristel M. van Asselt
Keyword(s):  
General Practice ◽  
Cervical Screening ◽  
Potential Barriers ◽  
Barriers And Enablers ◽  
Qualitative Exploration

Abstract The authors have withdrawn this preprint due to author disagreement.

scholarly journals Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. Meijer ◽  
R. M. J. J. Van der Kleij ◽  
N. H. Chavannes
Keyword(s):  
Smoking Cessation ◽  
General Practitioners ◽  
Large Scale ◽  
Smoking Status ◽  
Healthcare Providers ◽  
Regression Tree ◽  
Role Identity ◽  
Regression Analyses ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer. Methods Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses. Results The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes. Conclusions There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.

scholarly journals Improving Health Outcomes for People With Cancer in Rural and Regional Areas by Embedding Evidence-Based Smoking-Cessation Strategies Into Usual Care: A Study Protocol

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 95s-95s
Author(s):  
A. Ugalde ◽  
S. Aranda ◽  
C. Paul ◽  
L. Orellana ◽  
I. Plueckhahn ◽  
...  
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Health Service ◽  
Health Services ◽  
General Practitioners ◽  
Smoking Status ◽  
Routine Care ◽  
Evidence Based ◽  
Diagnosis Of Cancer ◽  
Care Costs

Background: Smoking following a diagnosis of cancer is a powerful clinical risk indicator, with known poorer health outcomes and associated health care costs. In Australia, smoking rates are higher in rural and regional areas. There are established and effective interventions to promote smoking cessation after a diagnosis of cancer yet these are not in routine practice. Aim: This protocol paper reports on a study that aims to embed evidence-based smoking cessation strategies for people with cancer who are current smokers into routine care, resulting in in system wide improvements, an implemented program and model for further dissemination. Methods: Across three rural/regional sites, and with partners Quit Victoria and Western Alliance, this study employs a variety of methodologies to embed smoking cessation support to improve outcomes for people with cancer who currently smoke. Specifically, the project will embed a system of responsibilities and training in rural and regional health services to routinely engage people with cancer who smoke in support services. The program will: · Promote routine delivery of smoking cessation care by trained oncology staff (oncologists/nurses/ allied health) · Establish referral pathways to Quitline · Correspond with general practitioners, to: i) outline the benefits of quitting in this context, ii) promote access to nicotine replacement therapy and iii) support quitting in the community. · Improve routine recording of smoking status and documentation of provision of brief intervention (personalised advice given, resources provided) and outcomes. Participants: are oncology staff and general practitioners across three health services: Ballarat Health Service, East Grampians Health Service (Ararat), Wimmera Health Care Group (Horsham), all located in Victoria, Australia. Data collection will occur across four sources: 1) Oncology staff: qualitative and quantitative data collection understanding confidence and views on provision on cessation advice; 2) Monitoring Quitline calls, 3) Interview with local general practitioners and 4) Medical record reviews to explore frequency of recording of smoking status. Data will be collected pre/postintervention. Results: The project is underway with the intervention manuals in development. The project is due for completion in 2020. Conclusion: This project takes a health services approach to integration of smoking cessation support in routine care for people with cancer in rural and regional areas. This program of work has capacity to determine best approaches to integrate smoking cessation into routine care, resulting in reduced mortality and morbidity, improved effectiveness of anticancer treatments, and reduced health care costs; by establishing internationally relevant, embedded health care interventions.

Does the smoking status of general practitioners affect the efficacy of smoking cessation counselling?

2009 ◽  
Vol 74 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Sabina Ulbricht ◽  
Sebastian E. Baumeister ◽  
Christian Meyer ◽  
Carsten Oliver Schmidt ◽  
Anja Schumann ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
General Practitioners ◽  
Smoking Status ◽  
Smoking Cessation Counselling
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