Missed opportunities for brief intervention in tobacco control in primary care: patients’ perspectives from primary health care settings in India

Abstract

BackgroundWorld Health Organization has called for tobacco cessation to be integrated into primary care. Primary Health Centres (PHC) offer opportunities for tobacco-use screening and brief cessation advice but data on such activities in developing countries such as India are limited. The aim of this study was to investigate screening and brief intervention practices of health service providers in primary care.MethodsThis cross-sectional study was conducted in 2012 among 1,549 patients aged over 18 years visiting PHCs in 12 districts of two Indian states- Andhra Pradesh and Gujarat. Responses were collected using an interviewer-administered questionnaire. Information was obtained on participants’ tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised to quit tobacco use. The primary outcome was whether patients were screened during their visit to the PHC. Data analysis was performed using multi-level logistic regression.ResultsLess than one-third (447) of patients were screened for tobacco use during their visit to the PHC. People presenting with respiratory complaints were 84% more likely (OR: 1.84; 95% CI: 1.30 to 2.62) to be screened for tobacco use when compared to those with general ailments. Number of quit attempts in the past 12 months was strongly associated with the outcome of being screened for tobacco use, indicating that people who had more than 5 quit attempts were two times more likely to be screened for tobacco use than those who had never attempted to quit tobacco (OR: 1.99; 95% CI: 1.03 to 3.8). Among the 447 patients who were screened for tobacco use, only 136 reported to have been counselled and merely 67 patients received suggestions on ways to quit tobacco.ConclusionOur results show that opportunities for screening and providing tobacco use cessation advice were largely missed by the health service providers. Our study suggests that there is an urgent need to incorporate tobacco cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and counselling to quit tobacco.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0714-6) contains supplementary material, which is available to authorized users.

Sociodemographic characteristics of tobacco users as determinants of tobacco use screening done by healthcare providers: Global Adult Tobacco Survey India 2009-2010

“…According to one study conducted in two Indian states (Andhra Pradesh and Gujarat), patients with respiratory illness were more likely to be screened for tobacco use by healthcare provider as compared to patients with general ailments. [ 25 ] Furthermore, patients with more than five previous quit attempts were more likely to be screened for tobacco use by healthcare provider as compared to patients with no previous quit attempts. [ 25 ] According to one study in South Africa, pregnant patients were more likely to be screened for tobacco use during antenatal care as compared to patients with other health problems.…”

“…[ 25 ] Furthermore, patients with more than five previous quit attempts were more likely to be screened for tobacco use by healthcare provider as compared to patients with no previous quit attempts. [ 25 ] According to one study in South Africa, pregnant patients were more likely to be screened for tobacco use during antenatal care as compared to patients with other health problems. [ 26 ]…”

Prevalência de estratégias para cessação do uso do tabaco na Atenção Primária à Saúde: uma revisão integrativa

“…O uso de medicamentos subsidiados associados a intervenções e campanhas públicas deve estar previsto nas políticas de combate ao tabagismo 8,33 . A intervenção intensiva e individualizada utilizando entrevista, terapias e medicamentos adaptados ao estágio de mudança motivacional do paciente favorece a abstinência e se mostra viável e eficaz na APS, com taxa de cessação de 26,1% após um ano [34][35][36] .…”

Practicing Health Promotion in Primary Care – A Reflective Enquiry

“…Recent data from Global Adult Tobacco Survey (GATS), India show that less than half of smokers who visited health care providers were advised to stop smoking [ 14 ]. Data from India also suggests that physicians lack skills in delivering brief intervention and counseling in tobacco cessation [ 15 , 16 ].…”