Opportunities for implementing smoking cessation interventions in primary care: a Breathe Well study

Abstract

Aim: To explore the acceptability to general practitioners (GPs) and patients of delivering and receiving lung age (LA) or exhaled CO feedback combined with very brief advice (VBA), or VBA alone, as part of a process evaluation of a randomized controlled trial (RCT). Method: Individual semi-structured interviews were conducted with GPs and patients involved in a smoking cessation trial from different regions in North Macedonia, sampled to ensure maximum variation of socio-demographic characteristics, smoking habits and motivation to quit smoking among patients, and characteristics and experience of GPs. Interviews were audio-recorded, transcribed intelligent verbatim, and analysed using the Framework method. Results: 26 GPs and 31 patients were interviewed. The patients who expressed a willingness to or had attempted to quit smoking after the interventions, associated quitting with strong motivation and resilient character. An important theme identified from interviewing patients was “Relationship-based care”: the importance of trust, strong relationships and communication between patients and GPs. For some patients this was the only reason to participate in the study, discuss cessation, receive intervention and attempt or succeed to quit. In contrast, GPs were influenced by a “system-view/approach to primary healthcare” which was not traditionally based on a culture of prevention, and in future they anticipated offering cessation advice and interventions, in their own time to those motivated to quit, or with pre-existing health problems. They preferred LA over CO. Conclusion: GPs are keen to support motivated patients to quit but need help to understand the motivations of those less inclined to quit, and have strategies to support them too. The primary care system needs to be improved to value prevention more. This study is a milestone in N. Macedonia, as a start of preventive-standard care and shifting patients’ expectations of primary care services. Declaration of Interest (including funding source and trial registration as appropriate) The authors declare no conflicts of interest. The NIHR Global Health Research (GHR) Programme is funded through UK Official Development Assistance (ODA) via the Department of Health and Social Care (DHSC). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. We gratefully acknowledge IPCRG for introducing us to the primary care networks involved in this study and for its continued facilitation of clinical engagement. The study is registered at http://www.isrctn.com (ISRCTN54228638). Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest References and Clinical Trial Registry Information