Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

Panaitescu, Cătălina; Moffat, Mandy; Williams, Siân; Pinnock, Hilary; Boros, Melinda; Oană, C; Alexiu, Sandra; Tsiligianni, Ioanna

doi:10.1038/npjpcrm.2014.22

Cited by 20 publications

(14 citation statements)

References 22 publications

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“…A recent study reported five main barriers to smoking interventions by PCPhs: limited perceived role for PCPhs, lack of time during consultations, past experience and presence of disincentives, patients’ inability to afford medications, and lack of training in smoking cessation skills [ 29 ]. In a previous study, the majority of PCPhs felt that smoking cessation support was too time consuming [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses

Sönmez¹,

Aydın²,

Türker³

et al. 2015

Tob. Induced Dis.

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BackgroundPrimary care providers are uniquely positioned to initiate smoking cessation. We aimed to evaluate knowledge levels about the health effects of smoking and attitudes toward smoking and tobacco control activities among primary care providers.MethodsIn the cross-sectional and primary care-based study, self-administered surveys modified from the WHO Global Health Professional Survey 5A steps of smoking cessation practice (Ask, Advise, Assess, Assist and Arrange) were provided to primary care physicians (PCPhs) and nurses (PCNs).ResultsRespondents included 1182 PCPhs and 1063 PCNs. The proportions of current and former smokers were significantly higher among PCPhs than among PCNs (34.4 vs. 30.7 % and 14.0 vs. 10.1 %, respectively; both P < 0.001). We observed that 77.2 % of PCPhs and 58.4 % of PCNs always or rarely practiced an “Ask” step about their patients’ smoking status (P < 0.001). One-third of PCPhs (33.8 %) stated that they always practiced an “Ask” step, whereas only 27.6 % of PCNs always did so in their practice (P < 0.001). A small minority of primary care providers had advised patients to quit smoking, although there was a significant difference in this between PCNs and PCPhs (8.4 vs. 15.6 %; P < 0.001). Most PCPhs considered themselves competent in advising about smoking interventions, but only a minority of PCNs did so (75.1 vs. 17.3 %; P < 0.001). Among barriers to tobacco intervention measures, lack of time was the item most commonly cited by PCPhs, whereas low patient priority was most commonly cited by PCNs (35.9 and 35.7 %; P < 0.001).ConclusionsSmoking intervention practice by primary care nurses was quite low. Lack of time and low patient priority were identified as barriers by primary care providers. Strategies by which primary care providers could improve tobacco control should be established.

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Section: Discussionmentioning

confidence: 99%

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses

Sönmez¹,

Aydın²,

Türker³

et al. 2015

Tob. Induced Dis.

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“…This diversity is contingent on several factors, among which are the smoking behavior of the GPs, their attitudes towards smoking, reservations regarding inducing anxiety or guilt among pregnant women, but also self-confidence in providing cessation support 23 . A qualitative study involving family physicians (general practitioners) in Romania suggested that they generally feel untrained to offer smoking cessation support, emphasizing the need to integrate appropriate training in their professional development 24 . More research should be conducted to assess the capacity of the healthcare system to effectively offer support to pregnant women in their cessation attempt.…”

Section: Discussionmentioning

confidence: 99%

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania

Brînzaniuc¹,

Strilciuc²,

Cherecheș³

et al. 2018

Tob. Prev. Cessation

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INTRODUCTION Smoking during pregnancy has negative effects on the mother and the unborn infant. Barriers to and facilitators of smoking cessation during pregnancy are context-dependent and multifaceted. This qualitative research explored pregnant women's experiences with smoking and cessation in Romania, and informed the development of a couple-focused smoking cessation intervention. METHODS Semi-structured, in-depth interviews were conducted via telephone, with 15 pregnant women who smoked during pregnancy or had quit smoking upon learning about the pregnancy or shortly before. A hybrid inductive-deductive approach to thematic analysis was used, to identify patterns in the data and explore women's narratives, in relation to smoking and smoking cessation. RESULTS Three main themes emerged from the data, which shaped the socio-cultural adaptation of the intervention to the local context: 1) Access to and mixed messages from the healthcare system that describe an inconsistent discourse from the healthcare system regarding smoking during pregnancy with some physicians not emphasizing the need for cessation, 2) Cessation as individual or team effort with variations in partner dynamics and difficulty in quitting that have important roles in perceptions about team efforts, and 3) Transition to motherhood and motivation to quit for the health of the pregnancy and infant, although in isolated cases women felt less connected with the pregnancy and such motivators. CONCLUSIONS Pregnant women in Romania face systemic, interpersonal, and individuallevel barriers that can be responsively integrated in smoking cessation interventions, by culturally adapting them to the local context.

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“…Initiatives on academic detailing or educational outreach carried out in developed countries 10 , 11 , 26 may not relate to the health service context in low- and middle-income countries. Implementation in countries (such as Brazil) where family medicine is an emerging speciality has specific challenges, as established hierarchies are challenged 27 and the boundaries shift between new professional roles. The WHO’s Package of Essential Non-Communicable Disease Interventions 28 advocates collaborative integrated care to improve case detection, diagnosis and management of respiratory disease, but there are a few implementation studies in low- and middle-income countries testing educational strategies to improve capacity and quality of care.…”

Section: Discussionmentioning

confidence: 99%

Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study

Martins

Salibe-Filho

Tonioli³

et al. 2016

npj Prim Care Resp Med

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Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented ‘matrix support’: a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157–87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems.

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Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

Cited by 20 publications

References 22 publications

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania

Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study

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