Sonmez Cemil Isik, Aydin Leyla Yilmaz, Turker Yasemin, Baltaci Davut, Dikici Suber, Sariguzel Yunus Cem, Alasan Fatih, Deler Mehmet Harun, Karacam Mehmet Serkan, Demir Mustafa
Department of Family Medicine, Duzce University, School of Medicine, Duzce, Turkey.
Department of Chest Diseases, Duzce University, School of Medicine, Duzce, Turkey.
Tob Induc Dis. 2015 Nov 12;13:37. doi: 10.1186/s12971-015-0062-7. eCollection 2015.
Primary 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.
In 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).
Respondents 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).
Smoking 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.
基层医疗服务提供者在启动戒烟工作方面具有独特的地位。我们旨在评估基层医疗服务提供者对吸烟健康影响的知识水平以及对吸烟和控烟活动的态度。
在这项基于基层医疗的横断面研究中，我们向基层医疗医生（PCPhs）和护士（PCNs）提供了根据世界卫生组织全球卫生专业人员调查中戒烟实践的5A步骤（询问、建议、评估、协助和安排）修改后的自填式调查问卷。
受访者包括1182名基层医疗医生和1063名护士。基层医疗医生中当前吸烟者和既往吸烟者的比例显著高于护士（分别为34.4%对30.7%以及14.0%对10.1%；P均<0.001）。我们观察到，77.2%的基层医疗医生和58.4%的护士总是或很少对患者的吸烟状况进行“询问”步骤（P<0.001）。三分之一的基层医疗医生（33.8%）表示他们总是进行“询问”步骤，而在实践中只有27.6%的护士总是这样做（P<0.001）。少数基层医疗服务提供者曾建议患者戒烟，尽管护士和基层医疗医生在此方面存在显著差异（8.4%对15.6%；P<0.001）。大多数基层医疗医生认为自己有能力就吸烟干预提供建议，但只有少数护士这样认为（75.1%对17.3%；P<0.001）。在烟草干预措施的障碍方面，基层医疗医生最常提到的是时间不足，而护士最常提到的是患者优先级低（分别为35.9%和35.7%；P<0.001）。
基层医疗护士的吸烟干预实践水平相当低。基层医疗服务提供者将时间不足和患者优先级低视为障碍。应制定基层医疗服务提供者可用于改善控烟工作的策略。
