Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.
SPECTRUM Consortium, London, UK.
BMC Prim Care. 2023 Jan 25;24(1):32. doi: 10.1186/s12875-023-01981-2.
Internationally, there is an 'evidence-practice gap' in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the 'real-world'.
To identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness.
'Embase', 'Medline', 'PsycINFO', 'CINAHL', 'Global Health', 'Social Policy & Practice', 'ASSIA Applied Social Sciences Index and Abstracts' databases, and grey literature sources were searched from inception to April 2021. Studies were included if they evaluated an implementation strategy implemented on a nation-/state-wide scale, targeting any type of healthcare professional within the primary care setting, aiming to increase smoking cessation treatment provision.
implementation strategy identification, and effectiveness (practitioner-/patient-level).
perceived facilitators and barriers to effectiveness, and cost-effectiveness. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the Expert Recommendations for Implementing Change (ERIC) compilation and the Consolidated Framework for Implementation Research (CFIR).
Of 49 included papers, half were of moderate/low risk of bias. The implementation strategy domains identified involved utilizing financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three increased practitioner-level smoking status recording and cessation advice provision. Interventions in the utilizing financial strategies domain also appeared to increase smoking cessation (patient-level). Key facilitator: external policies/incentives (tobacco control measures and funding for public health and cessation clinics). Key barriers: time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about available cessation support options. No studies assessed cost-effectiveness.
Some implementation strategy categories increased the rate of smoking status recording and cessation advice provision in primary care. We found some evidence for interventions utilizing financial strategies having a beneficial impact on cessation. Identified barriers to effectiveness should be reduced. More pragmatic approaches are recommended, such as hybrid effectiveness-implementation designs and utilising Multiphase Optimization Strategy methodology.
PROSPERO:CRD42021246683.
在国际上，医疗保健专业人员在临床实践中评估烟草使用情况并提供戒烟支持的比率存在“证据-实践差距”，包括在初级保健中。需要在“真实世界”中实施的策略来实施证据。
确定旨在增加初级保健中戒烟治疗提供的实施策略，评估其有效性、成本效益以及对有效性的任何感知促进因素和障碍。
从开始到 2021 年 4 月，检索了“Embase”、“Medline”、“PsycINFO”、“CINAHL”、“全球健康”、“社会政策与实践”、“ASSIA 应用社会科学索引和摘要”数据库和灰色文学资源。如果研究评估了在全国/州范围内实施的针对初级保健环境中任何类型的医疗保健专业人员的实施策略，旨在增加戒烟治疗的提供，则纳入研究。
实施策略的识别和有效性（从业者/患者水平）。
对有效性的感知促进因素和障碍，以及成本效益。使用非随机干预措施的风险评估工具（ROBINS-I）对研究进行评估。使用专家实施变革建议（ERIC）汇编和综合实施研究框架（CFIR）进行叙述性综合。
在 49 篇纳入的论文中，有一半的论文存在中度/低度偏倚风险。确定的实施策略领域涉及利用财务策略、改变基础设施、培训和教育利益相关者以及吸引消费者。前三个提高了从业者水平的吸烟状况记录和戒烟建议的提供。利用财务策略领域的干预措施似乎也增加了戒烟（患者水平）。主要促进因素：外部政策/激励措施（烟草控制措施和公共卫生和戒烟诊所的资金）。主要障碍：时间和财务限制、缺乏免费戒烟药物和随访、初级保健中的优先级降低和目标不明确、医疗保健专业人员知识不足以及对患者可用戒烟支持选项的信息传达不清楚。没有研究评估成本效益。
一些实施策略类别增加了初级保健中吸烟状况记录和戒烟建议的提供率。我们发现一些证据表明，利用财务策略的干预措施对戒烟有有益的影响。应减少对有效性的障碍。建议采用更务实的方法，例如混合有效性-实施设计和利用多阶段优化策略方法。
PROSPERO：CRD42021246683。
