Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies

BMC Primary Care

Research

Bernadett E. Tildy¹  Parvati R. Perman-Howe¹  Ann McNeill¹  Leonie S. Brose¹ 

[1] Addictions Department, King’s College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, SE5 8BB, London, UK;SPECTRUM Consortium, London, UK;

关键词: Systematic literature review;    Smoking;    Smoking cessation;    Tobacco;    Substance use;    Primary care;    General practice;    Implementation strategy;    5As;    Very brief advice;   

DOI  :  10.1186/s12875-023-01981-2

 received in 2022-05-18, accepted in 2023-01-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInternationally, 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’. Aim: 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.Methods‘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. Primary outcome measures: implementation strategy identification, and effectiveness (practitioner-/patient-level). Secondary outcome measures: 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).ResultsOf 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.ConclusionsSome 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.Protocol registrationPROSPERO:CRD42021246683

【 授权许可】

CC BY   
© The Author(s) 2023

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