| Summary: | 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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