Panda Rajmohan, Persai Divya, Venkatesan Sudhir
Public Health Foundation of India, New Delhi, India.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
BMC Health Serv Res. 2015 Feb 1;15:50. doi: 10.1186/s12913-015-0714-6.
World 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.
This 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.
Less 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.
Our 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.
世界卫生组织呼吁将戒烟纳入初级保健。初级卫生保健中心（PHC）为烟草使用筛查和简短戒烟建议提供了机会，但在印度等发展中国家，关于此类活动的数据有限。本研究的目的是调查初级保健中卫生服务提供者的筛查和简短干预做法。
这项横断面研究于2012年在印度安得拉邦和古吉拉特邦两个邦的12个区的初级卫生保健中心对1549名18岁以上的患者进行。使用访谈员管理的问卷收集回答。获得了参与者的烟草使用状况、就医原因、是否接受过烟草使用筛查及被建议戒烟的信息。主要结果是患者在就诊初级卫生保健中心期间是否接受了筛查。使用多水平逻辑回归进行数据分析。
不到三分之一（447名）的患者在就诊初级卫生保健中心期间接受了烟草使用筛查。与患有一般疾病的患者相比，出现呼吸道疾病症状的人接受烟草使用筛查的可能性高84%（比值比：1.84；95%置信区间：1.30至2.62）。过去12个月内的戒烟尝试次数与接受烟草使用筛查的结果密切相关，这表明有超过5次戒烟尝试的人接受烟草使用筛查的可能性是从未尝试戒烟者的两倍（比值比：1.99；95%置信区间：1.03至3.8）。在447名接受烟草使用筛查的患者中，只有136名报告接受过咨询，仅有67名患者收到了戒烟方法的建议。
我们的结果表明，卫生服务提供者在很大程度上错过了筛查和提供戒烟建议的机会。我们的研究表明，迫切需要将戒烟干预作为标准做法的一部分，以便让所有患者都有机会被询问其烟草使用情况，并获得戒烟建议和咨询。
