The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands.
Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
BMC Health Serv Res. 2023 Jun 19;23(1):654. doi: 10.1186/s12913-023-09692-1.
The Ask-Advise-Connect approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The approach has not yet been implemented in general practice in the Netherlands. The aim of this study was to investigate the influence of a comprehensive implementation strategy on the delivery of Ask-Advise-Connect for smoking cessation within Dutch general practice during the COVID-19 pandemic.
A pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers (GPs, practice nurses and doctor's assistants). Participation lasted nine months: during the first three months participants delivered smoking cessation care as usual (pre-intervention); the implementation strategy came into effect after three months and participants were followed up for another six months (post-intervention). The implementation strategy consisted of two meetings in which participants were educated about Ask-Advise-Connect, made agreements on the implementation of Ask-Advise-Connect and reflected on these agreements. Participants also received online educational materials and a desk card as reminder. The changes in the proportions of 'Ask' and 'Advise' over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling.
Participants provided consultations to 29,112 patients (both smokers and non-smokers). Results of the linear mixed effects model show that the proportion of patients that were asked about smoking ('Ask') significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit smoking ('Advise'). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling post-intervention ('Connect').
The findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice and proactive referral.
“询问-建议-转介”方法可以帮助初级保健提供者增加尝试戒烟并接受戒烟咨询的吸烟者人数。该方法尚未在荷兰的常规实践中实施。本研究旨在调查在 COVID-19 大流行期间，一种综合实施策略对荷兰常规实践中提供戒烟“询问-建议-转介”服务的影响。
本研究采用前后测设计，于 2020 年末至 2022 年初进行，共纳入 106 名荷兰初级保健提供者（全科医生、执业护士和医生助理）。参与时间为 9 个月：在最初的 3 个月内，参与者提供常规的戒烟护理（干预前）；在 3 个月后实施该策略，并在接下来的 6 个月内进行随访（干预后）。该实施策略包括两次会议，参与者在会议中接受关于“询问-建议-转介”的教育，就实施“询问-建议-转介”达成协议，并对这些协议进行反思。参与者还收到了在线教育材料和名片作为提醒。采用线性混合效应模型对“询问”和“建议”比例随时间的变化进行建模。关于转介至戒烟咨询的情况进行了描述性分析。
参与者共为 29112 名患者（包括吸烟者和非吸烟者）提供了咨询。线性混合效应模型的结果显示，在最初的 3 个月（干预前）中，被问及吸烟情况的患者比例（“询问”）显著下降，但在实施策略生效后又略有上升（干预后）。在建议患者戒烟的比例（“建议”）方面，未发现随时间的显著变化。描述性统计结果表明，更多的参与者在干预后更主动（而非被动）地将患者转介至戒烟咨询（“转介”）。
这些发现表明，综合实施策略可以支持初级保健提供者为患者提供戒烟护理，即使在 COVID-19 压力大的情况下也是如此。需要进一步的实施努力，以提高接受戒烟建议和主动转介的患者比例。
