Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2019 Feb 21;14(2):e0212641. doi: 10.1371/journal.pone.0212641. eCollection 2019.
A new intervention, Tobacco Cessation on Prescription (TCP), has been developed in the Swedish primary health care (PHC) setting to address inequalities in health caused by tobacco use. It consists of counseling for at least 10 minutes, an individualized prescription of tobacco cessation treatment and follow-up on at least one occasion. TCP is currently being tested in clinical practice for the first time but there is a lack of knowledge about how it is perceived by health care providers.
To explore PHC provider's perceived barriers and facilitators of implementing TCP as an intervention targeting a context with socioeconomically disadvantaged groups in Sweden.
Directed content analysis of transcripts from eight semi-structured interviews and one focus group interview with PHC providers with personal experience of TCP as informants. Data collection and analysis was guided by The Consolidated Framework for Implementation Research.
Perceived facilitators of implementing TCP were increased self-efficacy among the informants and involvement in the treatment among patients, which led to more intensive counseling and advice being taken more seriously by patients. Lack of resources, routines, and collaboration to work with tobacco cessation and lack of knowledge, motivation and self-efficacy among colleagues were perceived as barriers. Motivation and self-efficacy to quit was perceived as low among some patients, which was explained by low social support to quit, negative attitude and low adherence to treatment and tobacco being used as a coping strategy for life stress. Access to treatment for patients was limited by cost of treatment, long waiting times and focus on face-to-face counseling.
TCP was perceived positively by the informants but access to treatment for patients was partly limited by how tobacco cessation services were organized. Lack of structural support, resources and differing attitudes among PHC providers need to be addressed to facilitate its implementation.
在瑞典基层医疗保健（PHC）环境中开发了一种新的干预措施——处方戒烟（TCP），以解决因吸烟导致的健康不平等问题。它包括至少 10 分钟的咨询、个性化的戒烟治疗处方和至少一次随访。TCP 目前正在临床实践中首次进行测试，但对医疗保健提供者如何看待它缺乏了解。
探讨 PHC 提供者在实施 TCP 时面临的障碍和促进因素，TCP 是一种针对瑞典社会经济弱势群体的干预措施。
对有 TCP 个人经验的 PHC 提供者进行了八次半结构化访谈和一次焦点小组访谈的转录内容进行定向内容分析。数据收集和分析以实施研究综合框架为指导。
实施 TCP 的感知促进因素是参与者自我效能感的提高以及患者参与治疗，这导致更深入的咨询和建议更受患者重视。资源、常规和合作方面的缺乏、缺乏戒烟方面的协作以及知识、动机和自我效能感不足被视为障碍。一些患者戒烟的动机和自我效能感较低，这是由于戒烟的社会支持较低、对治疗的消极态度和低依从性以及将吸烟作为应对生活压力的一种策略所致。患者获得治疗的机会受到治疗费用、长时间等待和面对面咨询的限制。
TCP 得到了参与者的积极评价，但患者获得治疗的机会受到戒烟服务组织方式的部分限制。需要解决结构性支持、资源以及 PHC 提供者之间的不同态度问题，以促进其实施。
