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: 1.71). 02/2008; 8(1):6. DOI: 10.1186/1472-6963-8-6
Source: PubMed


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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    • "Our findings concur with previous research showing that those in more deprived socioeconomic groups are more likely to receive advice to quit smoking from their GP [13,24], perhaps suggesting that primary care health professionals are making a specific effort to target these groups in an attempt to reduce smoking-related inequalities. In addition, more deprived smokers may be more likely to want to receive advice on how to quit [24], and GPs may simply be responding to their patients’ wishes. However, analysis by Mosaic type suggests that some more deprived social groups, such as type K61 (low income farmers struggling on thin soils in isolated upland locations), are amongst the least likely to receive cessation advice. "
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    ABSTRACT: Background Smoking prevalence is particularly high amongst more deprived social groups. This cross-sectional study uses the Mosaic classification to explore socioeconomic variations in the delivery and/or uptake of cessation interventions in UK primary care. Methods Data from 460,938 smokers registered in The Health Improvement Network between 2008 and 2010 were analysed. Logistic regression was used to calculate odds ratios for smokers having a record of receiving cessation advice or a prescription for a cessation medication during the study period by Townsend quintile and for each of the 11 Mosaic groups and 61 Mosaic types. Both of these measures are area-level indicators of deprivation. Profiles of Mosaic categories were used to suggest ways to target specific groups to increase the provision of cessation support. Results Odds ratios for smokers having a record of advice or a prescription increased with increasing Townsend deprivation quintile. Similarly, smokers in more deprived Mosaic groups and types were more likely to have a documented cessation intervention. The odds of smokers receiving cessation advice if they have uncertain employment and live in social housing in deprived areas were 35% higher than the odds for successful professionals living in desirable areas (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.20-1.52; absolute risks 57.2% and 50.1% respectively), and those in low-income families living in estate-based social housing were 50% more likely to receive a prescription than these successful professionals (OR 1.50, 95% CI 1.31-1.73; absolute risks 19.5% and 13% respectively). Smokers who did not receive interventions were generally well educated, financially successful, married with no children, read broadsheet newspapers and had broadband internet access. Conclusions Wide socioeconomic variations exist in the delivery and/or uptake of smoking cessation interventions in UK primary care, though encouragingly the direction of this variation may help to reduce smoking prevalence-related socioeconomic inequalities in health. Groups with particularly low intervention rates may be best targeted through broadsheet media, the internet and perhaps workplace-based interventions in order to increase the delivery and uptake of effective quit support.
    Full-text · Article · Jun 2013 · BMC Public Health
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    • "In a study by Murray and colleagues [11,18], general practices identified all patients who were recorded as current smokers or with no status recorded, and proactively informed them by letter about the stop smoking services, giving the option of being contacted by an advisor. The proportion of current smokers expressing interest was 13.8%, suggesting that more than the current 5% of the smoking population setting quit dates within the NHS are interested in receiving help. "
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    ABSTRACT: Background Although government-funded specialist smoking cessation services in England offer advice and support to smokers motivated to quit, only a small proportion of smokers make use of this service. Evidence suggests that if smokers are proactively and personally invited to use services, use will be higher than with a standard referral made by health professionals. Computer-based systems generating personalised tailored communications also have the potential to engage with a larger proportion of the smoking population. In this study smokers are proactively invited to use the NHS Stop Smoking Service (SSS), with a personal computer-tailored letter and the offer of a no-commitment introductory session designed to give more information about the service. The primary objective is to assess the relative effectiveness on attendance at the NHS SSS, of proactive recruitment by a brief personal letter, tailored to individual characteristics, and invitation to a taster session, over a standard generic letter advertising the service. Method/design This randomised controlled trial will recruit smokers from general practice who are motivated to quit and have not recently attended the NHS SSS. Smokers aged 16 years and over, identified from medical records in participating practices, are sent a brief screening questionnaire and cover letter from their GP. Smokers giving consent are randomised to the Control group to receive a standard generic letter advertising the local service, or to the Intervention group to receive a brief personal, tailored letter with risk information and an invitation to attend a ‘Come and Try it’ taster session. The primary outcome, assessed 6 months after the date of randomisation, is the proportion of people attending the NHS SSS for at least one session. Planned recruitment is to secure 4,500 participants, from 18 regions in England served by an NHS SSS. Discussion Personal risk information generated by computer, with the addition of taster sessions, could be widely replicated and delivered cost effectively to a large proportion of the smoking population. The results of this trial will inform the potential of this method to increase referrals to specialised smoking cessation services and prompt more quit attempts. Trial registration Current Controlled Trials ISRCTN76561916
    Full-text · Article · Oct 2012 · Trials
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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.
    Full-text · Article · May 2012 · Journal of Substance Use
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