Dannapfel Petra, Bendtsen Preben, Bendtsen Marcus, Thomas Kristin
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Unit for Change Management and Support, Region Östergötland, Linköping, Sweden.
Front Health Serv. 2023 Oct 13;3:1201447. doi: 10.3389/frhs.2023.1201447. eCollection 2023.
The use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice.
To explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work.
A qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers.
Informants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools.
Implementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.
数字工具的使用被认为是解决基层医疗中提供预防服务面临的一些挑战的一种方法。尽管患者普遍接受使用数字自助工具戒烟，并且医疗保健机构也越来越多地被敦促将这些工具纳入临床实践，但尚不清楚这些创新如何以及适用于哪些人才能被纳入临床实践。
探讨医疗保健专业人员对常规基层医疗中戒烟实践以及在这项工作中使用数字工具的看法。
对瑞典基层医疗领域的医疗保健专业人员进行了9次深入电话访谈的定性研究。采用便利抽样和滚雪球技术作为招募策略。受访者包括注册护士、地区护士、辅助护士以及行为治疗师。所有受访者均为女性，年龄在43至57岁之间，有基层医疗戒烟工作经验，并且有可能向吸烟者推荐数字干预措施。
受访者将基层医疗中的戒烟实践描述为：（i）识别吸烟患者；（ii）遵循标准化的戒烟实践流程；（iii）将戒烟实践列入议程。受访者描述数字工具的使用方式有：（i）复制实践；（ii）补充实践；（iii）便于接触医疗保健从业者。最后，分析表明患者的期望和行为影响了戒烟实践的方式和时间，包括数字工具的使用。
在瑞典基层医疗中实施戒烟实践包括持续努力接触吸烟患者、在同行中获得支持以及将烟草问题列入实践议程。数字干预措施用于复制、补充和便于获得护理。研究结果表明，工作人员的连续性差以及对预防工作的消极态度可能会对戒烟实践构成挑战。然而，社会对烟草使用健康风险认识的变化，包括关于吸烟接受度的社会规范转变，可能有助于在基层医疗实践中谈论吸烟常态化。需要更多关于如何以及适用于哪些人的知识，以便将数字工具纳入临床实践。
