Weak smoking cessation awareness in primary health care before surgery: a real-world, retrospective cohort study

Abstract

Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. Design: This was a retrospective cohort study. Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation. Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016. Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records. Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n ¼ 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p .001). Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates. KEY POINTSTobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care. ARTICLE HISTORY

Documentation of smoking in scheduled asthma contacts in primary health care: a 12-year follow-up study

“…In Sweden, smoking cessation support was offered to 27% of 12–17 year old adolescent asthmatics, to 38% of adult-asthmatics and to 51% of the patients with COPD 13 . Based on our study and previous studies 49 , 50 , 54 , 55 it could be argued that smoking cessation activities in PHC in Finland have remained inadequate despite asthma guidelines 1 , 22 and national smoking cessation guidelines since 2002 56 . Although there is strong evidence for the benefits of quitting smoking, its implementation is shown to be poor not only in respiratory diseases but also in many other conditions 21 , 44 , 53 , 57 .…”

“…Our results, suggesting that smoking was recorded in less than every fifth scheduled asthma contact and pack-years in <7% of contacts, may reflect the possible national neglecting attitudes toward smoking habits in PHC in accordance with previous study showing that smoking habits was mentioned only in 42% of asthma referral letters sent to respiratory department 49 . In addition, in more recent Finnish study, recording of smoking status was visible in 14.2% of the PHC referrals to operative care and very little attention was paid to the need for preoperative smoking cessation in PHC 50 . During the Finnish National COPD program written information on smoking habits in records increased from 16.6% of all patients with respiratory symptoms in 1997 to 53.2% in 2002 and in COPD group from 45.0 to 84.3% 51 .…”

“It Is A Carrot-Stick Model”: A Qualitative Study of Rural-Serving Clinician and Rural-Residing Veteran Perceptions of Requirements to Quit Smoking prior to Elective Surgery

“…This could be due to lack of care coordination or communication, fear of harming the patient-clinician relationship, insufficient training on intervention techniques, or limited knowledge related to requirements (e.g., use of medications and length of abstinence). Further, primary care clinicians and surgery staff may have little time or knowledge about the perioperative effects of smoking on surgeries, which may in part be why patients continue to smoke [5,9,10].…”

Treatment of nicotine dependence needs be strengthened in primary health care

“…Another example of this need is a real-world study by Gräsbeck et al. [ 9 ] on primary health care referrals of all patients aged 16 and over who underwent surgery at Porvoo Hospital in Finland ( n = 1482). They found a weak smoking cessation awareness in primary health care before surgery, as preoperative smoking cessation for current smokers was visible in only 2.2% of referrals.…”