RESEARCH PAPER
Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention?
 
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1
Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
2
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
3
Faculty of Medicine, University of Ottawa, Ottawa, Canada
4
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
5
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
CORRESPONDING AUTHOR
Sophia Papadakis   

Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Crete, Greece
Publish date: 2018-05-21
 
Tob. Induc. Dis. 2018;16(May):21
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece.

Methods:
We conducted a secondary analysis of data derived from a quasiexperimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery.

Results:
Our analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination.

Conclusions:
Providers are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.

 
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