Panda Rajmohan, Persai Divya, Venkatesan Sudhir, Ahluwalia Jasjit S
Public Health Foundation of India, New Delhi, India.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
BMC Public Health. 2015 May 2;15:456. doi: 10.1186/s12889-015-1803-5.
Tobacco cessation interventions by physicians hold promise in improving quit rates. The 5As intervention ('Ask', 'Advise', 'Assess', 'Assist' and 'Arrange') is an evidence-based approach for tobacco cessation. However, little is known about adherence with the tobacco cessation interventions in primary care in India. In the present study we assessed physicians' adherence with the 5As intervention and explored physician and patient concordance on the report of 5As intervention for tobacco cessation.
We used data from two cross-sectional surveys conducted in 12 districts of Andhra Pradesh and Gujarat in India. The surveys were administered simultaneously to both patients attending, and physicians working in health facilities providing primary care. Health facilities were selected by systematic random sampling and patients were recruited by simple random sampling. Common health facilities where both surveys were performed were identified, and individual patients were matched to their physicians through a unique matching code to obtain the two study samples.
Slight agreement was observed between the physician and patient responses on 'Ask' and 'Arrange' component of the 5As intervention. The 'Advise', 'Assess' and 'Assist' components showed low agreement. Slightly higher levels of agreement were seen on all components of the 5As, except 'Advise', for those patients who had made an attempt to quit.
Our study suggests an urgent need for revising current strategies in order to strengthen the 'Advise', 'Assess', and 'Assist' interventions in tobacco cessation in primary care settings. Patient surveys should be used routinely in assessing fidelity and provider adherence for large scale behavioral health programs.
医生实施的戒烟干预措施有望提高戒烟成功率。5A干预法（“询问”“建议”“评估”“协助”和“安排”）是一种基于证据的戒烟方法。然而，关于印度初级保健中戒烟干预措施的依从性知之甚少。在本研究中，我们评估了医生对5A干预法的依从性，并探讨了医生与患者在戒烟5A干预报告方面的一致性。
我们使用了在印度安得拉邦和古吉拉特邦12个地区进行的两项横断面调查的数据。对在提供初级保健的卫生机构就诊的患者和工作的医生同时进行调查。通过系统随机抽样选择卫生机构，通过简单随机抽样招募患者。确定同时进行两项调查的常见卫生机构，并通过唯一的匹配代码将个体患者与其医生匹配，以获得两个研究样本。
在5A干预法的“询问”和“安排”部分，医生和患者的回答之间观察到轻微一致性。“建议”“评估”和“协助”部分显示出较低的一致性。对于那些尝试戒烟的患者，除“建议”外，在5A的所有部分都观察到略高的一致性水平。
我们的研究表明迫切需要修订当前策略，以加强初级保健环境中戒烟的“建议”“评估”和“协助”干预措施。在评估大规模行为健康项目的保真度和提供者依从性时，应常规使用患者调查。
