Jradi Hoda
a Department of Community and Environmental Health , College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences , Riyadh , Saudi Arabia.
J Addict Dis. 2017 Jan-Mar;36(1):53-59. doi: 10.1080/10550887.2015.1116355. Epub 2015 Nov 13.
Smoking cessation counseling and therapy provided by physicians play an important role in helping smokers quit. Awareness and practices of the clinical practice guidelines for tobacco dependence (in particular the 5A's: Ask, Assist, Assess, Advise, and Arrange) among physicians and perceived barriers for their implementation is needed to improve care for individuals who smoke/use tobacco products in Saudi Arabia. A cross-sectional self-administered survey was conducted among 124 general and family practitioners in primary health care clinics belonging to 2 major medical centers in Riyadh city, Saudi Arabia. Descriptive statistics were reported for all survey variables. Logistic regression was used to examine the predictors of physicians' use of the 5A's for smoking cessation counseling and therapy. Among the 216 contacted physicians, 124 responded (57.4%). The majority (63.7%) were males, between the ages of 40 and 49 years (52.4%), practicing full-time (95.2%), and had not received smoking cessation training during medical school education or residency training (68.6%). Approximately 85.5% reported some experience with the guidelines (heard, read, or used). Asking (71.8%) and advising (87.9%) were the most implemented for smoking cessation, while assisting (15.3%) and arranging for follow-up (17.7%) were the least implemented. Most (96.0%) did not prescribe pharmacotherapy and 53.2% reported documenting the patient's smoking status. Reported barriers were mostly lack of time (72.6%) and lack of training (66.9%). Awareness of the guidelines, physician's smoking status, perceived competence in ability to provide smoking cessation counseling and therapy, reporting the ineffectiveness of smoking cessation therapy as a barrier, and the perceived benefit of reducing patient's physical symptoms were independently statistically significant predictors of the implementation of the 5A's for smoking cessation therapy. This preliminary study showed that smoking cessation delivery, according to the clinical practice guidelines recommendation, in Saudi Arabia is inadequate. Barriers were identified regarding the delivery of smoking cessation therapy and counseling for the first time. Physician training is likely to improve compliance with implementing smoking cessation counseling and therapy.
医生提供的戒烟咨询和治疗在帮助吸烟者戒烟方面发挥着重要作用。了解医生对烟草依赖临床实践指南（特别是5A法：询问、协助、评估、建议和安排）的认知及实践情况，以及其实施过程中存在的阻碍因素，对于改善沙特阿拉伯吸烟/使用烟草制品人群的护理至关重要。在沙特阿拉伯利雅得市2个主要医疗中心所属的初级保健诊所，对124名全科医生和家庭医生开展了一项横断面自填式调查。报告了所有调查变量的描述性统计数据。采用逻辑回归分析来检验医生在戒烟咨询和治疗中使用5A法的预测因素。在216名联系到的医生中，124名给予了回复（回复率为57.4%）。大多数（63.7%）为男性，年龄在40至49岁之间（52.4%），全职执业（95.2%），且在医学院教育或住院医师培训期间未接受过戒烟培训（68.6%）。约85.5%的医生表示对指南有一定了解（听说过、阅读过或使用过）。在戒烟方面，询问（71.8%）和建议（87.9%）的实施最为普遍，但协助（15.3%）和安排随访（17.7%）的实施最少。大多数（96.0%）医生未开具药物治疗，53.2%的医生报告记录了患者的吸烟状况。报告的阻碍因素主要是时间不足（72.6%）和缺乏培训（66.9%）。对指南的认知、医生的吸烟状况、提供戒烟咨询和治疗的自我感知能力、将戒烟治疗无效作为阻碍因素的报告以及减轻患者身体症状所带来的感知益处，均是戒烟治疗实施5A法具有统计学意义上的独立预测因素。这项初步研究表明，在沙特阿拉伯，按照临床实践指南的建议进行戒烟治疗的情况并不理想。首次明确了戒烟治疗和咨询实施过程中的阻碍因素。医生培训可能会提高对实施戒烟咨询和治疗的依从性。
