Opportunities missed: a cross-sectional survey of the provision of smoking cessation care to pregnant women by Australian general practitioners and obstetricians

Bar Zeev, Yael, Bonevski, Billie, Twyman, Laura, Watt, Kerrianne, Atkins, Lou, Palazzi, Kerrin, Oldmeadow, Christopher, and Gould, Gillian S. (2017) Opportunities missed: a cross-sectional survey of the provision of smoking cessation care to pregnant women by Australian general practitioners and obstetricians. Nicotine and Tobacco Research, 19 (5). pp. 636-641.

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Abstract

Introduction: Similar to other high-income countries, smoking rates in pregnancy can be high in specific vulnerable groups in Australia. Several clinical guidelines exist, including the 5A’s (Ask, Advice, Assess, Assist, and Arrange), ABCD (Ask, Brief advice, Cessation, and Discuss), and AAR (Ask, Advice, and Refer). There is lack of data on provision of smoking cessation care (SCC) of Australian General Practitioners (GPs) and Obstetricians.

Methods: A cross-sectional survey explored the provision of SCC, barriers and enablers using the Theoretical Domains Framework, and the associations between them. Two samples were invited: (1) GPs and Obstetricians from a college database (n = 5571); (2) GPs from a special interest group for Indigenous health (n = 500). Dimension reduction for the Theoretical Domains Framework was achieved with factor analysis. Logistic regression was carried out for performing all the 5A’s and the AAR.

Results: Performing all of the 5A’s, ABCD, and AAR “often and always” was reported by 19.9%, 15.6%, and 49.2% respectively. “Internal influences” (such as confidence in counselling) were associated with higher performance of the 5A’s (Adjusted OR 2.69 (95% CI 1.5, 4.8), p < .001), whereas “External influences” (such as workplace routine) were associated with higher performance of AAR (Adjusted OR 1.7 (95% CI 1, 2.8), p = .035).

Conclusions: Performance in providing SCC to pregnant women is low among Australian GPs and Obstetricians. Training clinicians should focus on improving internal influences such as confidence and optimism. The AAR may be easier to implement, and interventions at the service level should focus on ensuring easy, effective, and acceptable referral mechanisms are in place.

Implications: Improving provision of the 5A’s approach should focus on the individual level, including better training for GPs and Obstetricians, designed to improve specific “internal” barriers such as confidence in counselling and optimism. The AAR may be easier to implement in view of the higher overall performance of this approach. Interventions on a more systemic level need to ensure easy, effective, and acceptable referral mechanisms are in place. More research is needed specifically on the acceptability of the Quitline for pregnant women, both Indigenous and non-Indigenous.

Item ID: 49634
Item Type: Article (Research - C1)
ISSN: 1469-994X
Keywords: smoking cessation; primary care; pregnant women
Funders: Royal Australian College of General Practitioners (RACGP), National Health and Medical Research Council (NHMRC), Hunter Cancer Research Alliance, University of Newcastle (UoN)
Projects and Grants: RACGP Chris Silagy Scholarship, NHMRC Early Career Fellowship, NHMRC Career Development Fellowship, UoN Gladys M Brown Career Develoment Fellowship
Date Deposited: 24 Jul 2017 05:20
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 35%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 35%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111710 Health Counselling @ 30%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920507 Womens Health @ 50%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920414 Substance Abuse @ 50%
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