Optimizing Smoking Cessation Counseling in a University Hospital: Results and Pitfalls

Healthcare providers' knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape

Background

Clinicians are crucial in encouraging smokers to quit through behavioural or pharmacological smoking cessation interventions. Smokers quit better with professional help. The level of healthcare providers' (HCPs) knowledge, attitudes and counselling skills related to effective smoking cessation support in the study area remains uncertain.

Aim

The study aimed to determine HCPs' knowledge, attitudes and practices (KAP) on smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape.

Setting

Sol Plaatje's 13 district municipality clinics, Kimberley, Northern Cape.

Method

A descriptive, cross-sectional analytical study involving healthcare workers in the above setting.

Results

A total of 165 HCPs, including medical officers, professional nurses, enrolled nurses and assistant-enrolled nurses working in primary healthcare clinics, were invited to participate in the study, with 156 completing the questionnaires. About 53.9% had no knowledge of South African tobacco smoking cessation guidelines, while 87.2% knew the importance of counselling patients about smoking and its impact on quitting. The majority of them did not know the medicines recommended for tobacco treatment in South Africa. About 89.7% expressed that smoking cessation counselling is an important part of their jobs. However, less than half indicated that they make follow-up arrangements for those attempting to quit.

Conclusion

The study revealed gaps in KAP regarding smoking cessation among the respondents, necessitating the need for continuing education on the existing smoking cessation guidelines among these HCPs.

Contribution

The results of this study will help to improve smoking cessation intervention knowledge among health providers.

The delivery of Ask-Advise-Connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: results of a pre-post implementation study

BACKGROUND

The Ask-Advise-Connect approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The approach has not yet been implemented in general practice in the Netherlands. The aim of this study was to investigate the influence of a comprehensive implementation strategy on the delivery of Ask-Advise-Connect for smoking cessation within Dutch general practice during the COVID-19 pandemic.

METHODS

A pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers (GPs, practice nurses and doctor's assistants). Participation lasted nine months: during the first three months participants delivered smoking cessation care as usual (pre-intervention); the implementation strategy came into effect after three months and participants were followed up for another six months (post-intervention). The implementation strategy consisted of two meetings in which participants were educated about Ask-Advise-Connect, made agreements on the implementation of Ask-Advise-Connect and reflected on these agreements. Participants also received online educational materials and a desk card as reminder. The changes in the proportions of 'Ask' and 'Advise' over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling.

RESULTS

Participants provided consultations to 29,112 patients (both smokers and non-smokers). Results of the linear mixed effects model show that the proportion of patients that were asked about smoking ('Ask') significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit smoking ('Advise'). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling post-intervention ('Connect').

CONCLUSIONS

The findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice and proactive referral.

Implementation of ask-advise-connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: a mixed-methods evaluation using the CFIR framework

BACKGROUND

The Ask-Advise-Connect (AAC) approach can help primary care providers to increase the number of people who attempt to quit smoking and enrol into cessation counselling. We implemented AAC in Dutch general practice during the COVID-19 pandemic. In this study we describe how AAC was received in Dutch general practice and assess which factors played a role in the implementation.

METHODS

A mixed-methods approach was used to evaluate the implementation of AAC. Implementation took place between late 2020 and early 2022 among 106 Dutch primary care providers (general practitioners (GPs), practice nurses and doctor's assistants). Quantitative and qualitative data were collected through four online questionnaires. A descriptive analysis was conducted on the quantitative data. The qualitative data (consisting of answers to open-ended questions) were inductively analysed using axial codes. The Consolidated Framework for Implementation Research was used to structure and interpret findings.

RESULTS

During the study, most participants felt motivated (84-92%) and able (80-94%) to apply AAC. At the end of the study, most participants reported that the AAC approach is easy to apply (89%) and provides advantages (74%). Routine implementation of the approach was, however, experienced to be difficult. More GPs (30-48%) experienced barriers in the implementation compared to practice nurses and doctor's assistants (7-9%). The qualitative analysis showed that especially external factors, such as a lack of time or priority to discuss smoking due to the COVID-19 pandemic, negatively influenced implementation of AAC.

CONCLUSIONS

Although AAC was mostly positively received in Dutch general practice, implementation turned out to be challenging, especially for GPs. Lack of time to discuss smoking was a major barrier in the implementation. Future efforts should focus on providing additional implementation support to GPs, for example with the use of e-health.