Missed opportunities: general practitioner identification of their patients’ smoking status

BMC Family Practice

Research Article

Alessandra Bisquera¹  Mariko Carey²  Elise Mansfield²  Tim Regan²  Rob Sanson-Fisher²  Jamie Bryant² 

[1] Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, University of Newcastle, HMRI Building, 2308, Callaghan, NSW, Australia;Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia;

关键词: General practice;    Detection;    Smoking;    Smoking cessation;   

DOI  :  10.1186/s12875-015-0228-7

 received in 2014-10-28, accepted in 2015-01-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients’ use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use.MethodsEligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient’s consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use.ResultsFifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59–73] while specificity was 98% [95% CI 97–98]. Positive predictive value was 78% [95% CI 71–85] and negative predictive value was 96% [95% CI 95–97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded ‘Other’ were less likely to be detected as smokers than patients who had completed a high school or below level of education.ConclusionDespite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient’s smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.

【 授权许可】

CC BY   
© Bryant et al.; licensee BioMed Central. 2015