The potential to improve ascertainment and intervention to reduce smoking in Primary Care: a cross sectional survey

Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK.
BMC Health Services Research (Impact Factor: 1.66). 02/2008; 8:6. DOI: 10.1186/1472-6963-8-6
Source: PubMed

ABSTRACT Well established clinical guidelines recommend that systematic ascertainment of smoking status and intervention to promote cessation in all smokers should be a fundamental component of all health care provision. This study aims to establish the completeness and accuracy of smoking status recording in patients' primary care medical records and the level of interest in receiving smoking cessation support amongst primary care patients in an inner city UK population.
Postal questionnaires were sent to all patients aged over 18 from 24 general practices in Nottingham UK who were registered as smokers or had no smoking status recorded in their medical notes.
The proportion of patients with a smoking status recorded varied between practices from 42.4% to 100% (median 90%). Of the recorded smokers who responded to our questionnaire (35.5% of the total), a median of 20.3% reported that they had not smoked cigarettes or tobacco in the last 12 months. Of respondents with no recorded smoking status, 29.8% reported themselves to be current smokers. Of the 6856 responding individuals thus identified as current smokers, 41.4% indicated that they would like to speak to a specialist smoking adviser to help them stop smoking. This proportion increased with socioeconomic disadvantage (measured by the Townsend Index) from 39.1% in the least deprived to 44.6% in the most deprived quintile.
Whilst in many practices the ascertainment of smoking status is incomplete and/or inaccurate, failure to intervene appropriately on known status still remains the biggest challenge.
Current Controlled Trials ISRCTN71514078.

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    • "the question, or has an obvious tobacco-related disease, or when the smoker has been identified as such by OHPs in the clinical records. Our findings, as in other studies (Mant et al., 2000; Selak et al., 2006; Murray et al., 2008; Wye et al., 2010), show that monitoring smoking status and record-keeping procedures, including tobacco use diagnosis, are one of the weak links in cessation intervention. Identifying smoking status and recording increases the rate of clinical intervention, which has been shown to increase cessation attempts (Raw et al., 1998; Fiore et al., 2008). "
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    ABSTRACT: Background: Smoking cessation should be a top priority in hospitals. In November 2007, a Portuguese teaching hospital carried out a survey to evaluate cessation attitudes, clinical practices and cessation training needs among hospital-based healthcare providers (HCPs). The study also aimed to identify factors associated with cessation attitudes and practices, self-confidence to intervene and awareness of training programs. Method: This is a cross sectional questionnaire-based study including all HCPs. Sample: The study sample covers 424 HCPs, of which 65.4% were females. Mean age of these HCPs was 38.7 AE 10.1 years and the overall response rate was 50.5%. For data analyses, chi-squared tests, McNemar tests and multiple logistic regression models were used. Results: Most physicians and nurses reported "Asking" and "Advising" always or often. Other HCPs reported low frequencies of "Asking" and "Advising" (p < 0.001). Systematic "Asking" was reported less often than "Advising" (p < 0.001). Most HCPs did not record cessation practices, lacked specific training, and were not aware of their training needs. Reported self-confidence, positive attitudes and being a physician or non-smoker were the factors that influenced cessation practices the most. Conclusion: The findings suggest that there is reason to doubt that cessation practices are being under-taken effectively. Hospitals should audit smoking status recording, delivery of effective cessation advice and post-discharge support. Cessation indicators should be mandatory in all healthcare settings. To achieve these goals, undergraduate and graduate cessation training must be given higher priority.
    Journal of Substance Use 05/2012; 31 May 2012 Early Online(31 May 2012 Early Online-2012 Early Online: 1–12):1--12. DOI:10.3109/14659891.2012.685792 · 0.48 Impact Factor
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    ABSTRACT: Background Motor Vehicle Crashes (MVCs) are a major cause of morbidity and mortality worldwide. This thesis explores the potential use of large databases of primary care medical records to investigate the epidemiology of MVCs in the United Kingdom and to supplement the data available from national statistics, which are believed to understate both the number of crashes, and the number of injuries which occur as a result. Methods Details of all individuals enrolled in The Health Improvement Network (THIN) database whose primary care records indicated involvement in a MVC were used to calculate a series of summary measures describing the burden and consequences of MVCs. These were compared with data available from police accident reports and from hospital admissions. Data from THIN were used to conduct a series of studies of the impact of health and healthcare-related factors on the risk of involvement in MVCs. Specifically: a case-control study of the impact of modifiable lifestyle factors on the risk of MVC; case-crossover and self-controlled case-series studies of the effect of exposure to prescribed medications on the risk of MVC; a case-control study investigating the impact of disordered sleep on the risk of MVC; a case-control study of the risk of involvement in MVC among individuals with diabetes relative to the general population; and; a cohort study assessing whether there is evidence to suggest that involvement in a MVC may indicate the presence of undiagnosed disease which may impair driving performance. Results The socio-demographic characteristics of individuals involved in MVCs recorded in THIN differ markedly from those recorded in police accident reports and hospital admissions data. There was no evidence of consistent trends in MVC incidence over time in the three data sources. Differences in data collection methodology and the severity and scope of crashes recorded may account for these variations. Evidence was found of an association between having a high Body Mass Index and involvement in MVCs, and between past (but not current) smoking and involvement in MVCs, however the recording of data on lifestyle-related exposures such as smoking and alcohol consumption in the age-groups most likely to be involved in MVCs was poor, complicating interpretation of these results. Current exposure to benzodiazepines and preparations containing opioid analgesics was found to increase the risk of involvement in MVCs, as was longer-term use of non-benzodiazepine hypnotics, selective serotonin reuptake inhibitors and antihistamines. No increased risk of MVC was observed with exposure to beta-blockers or tricyclic antidepressants. Individuals reporting insomnia or snoring to their primary care practitioner were found to be at increased risk of MVC, as were individuals with diagnosed sleep apnoea. This association was independent the use of sedative or antidepressant medications. Individuals with diabetes were not found to be at an increased risk of MVC compared with the general population, and there was no difference in risk between those receiving different forms of treatment. Involvement in a MVC was associated with an increased risk of being diagnosed with cardiac disease in the two years following the crash. Conclusions Current sources of data about MVCs in the UK use different data collection methodologies, none of which is likely to accurately describe the overall burden of MVCs in the population. Primary care data remain a useful resource for those wishing to study the epidemiology of MVCs, but care must be taken to ensure that the uses to which the data are put are appropriate. Studies investigating lifestyle-related exposures are unlikely to produce reliable results as primary care recording of such factors is poor in the age-groups most likely to be involved in MVCs. Primary care data are more useful when studying the time course of pharmacological effects, or the effects of diagnosed illness, and can successfully detect previously observed associations. Primary care data is currently of little use in the study of injuries associated with involvement in MVCs as it is rare for both an injury and its proximate cause to be recorded. The investigation of methods by which this problem might be resolved is an important avenue for future research.
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    ABSTRACT: To establish whether proactively identifying all smokers in primary care populations and offering smoking cessation support is effective in increasing long-term abstinence from smoking. Cluster randomized controlled trial. Twenty-four general practices in Nottinghamshire, randomized by practice to active or control intervention. All adult patients registered with the practices who returned a questionnaire confirming that they were current smokers (n = 6856). Participants were offered smoking cessation support by letter and those interested in receiving it were contacted and referred into National Health Service (NHS) stop smoking services if required. Validated abstinence from smoking, use of smoking cessation services and number of quit attempts in continuing smokers at 6 months. Smokers in the intervention group were more likely than controls to report that they had used local cessation services during the study period [16.6% and 8.9%, respectively, adjusted odds ratio (OR) 2.09, 95% confidence interval (CI) 1.57-2.78], and continuing smokers (in the intervention group) were more likely to have made a quit attempt in the last 6 months (37.4% and 33.3%, respectively, adjusted OR 1.23, 95% CI 1.01-1.51). Validated point prevalence abstinence from smoking at 6 months was higher in the intervention than the control groups (3.5% and 2.5%, respectively) but the difference was not statistically significant (adjusted OR controlling for covariates: 1.64, 95% CI 0.92-2.89). Proactively identifying smokers who want to quit in primary care populations, and referring them to a cessation service, increased contacts with cessation services and the number of quit attempts. We were unable to detect a significant effect on long-term cessation rates, but the study was not powered to detect the kind of difference that might be expected.
    Addiction 07/2008; 103(6):998-1006; discussion 1007-8. DOI:10.1111/j.1360-0443.2008.02206.x · 4.60 Impact Factor
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