‘Why do we have to be the gatekeepers?’ Australian general practitioner’s knowledge, attitudes and prescribing intentions on e-cigarettes as a smoking cessation aid

Abstract

Background: A significant policy change impacting the availability of nicotine for use in electronic cigarettes (e-cigarettes) in Australia took effect from October 1, 2021. This change meant that nicotine containing liquids for use with e-cigarettes would only be available by prescription from a medical practitioner as part of a smoking cessation plan. This study aimed to explore General Practitioner’s (GP’s) perceptions about the role of e-cigarettes, and understand factors informing their intentions to prescribe nicotine e-liquid as part of a smoking cessation plan. Methods: In-depth semi-structured interviews were conducted with thirteen GP’s. Purposeful sampling was used to recruit participants. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to classify, describe and report themes in the data. QSR NVivo was used to aid coding, thematic analysis and retrieval of quotes. Results: Australian GP’s had diverse views on recommending e-cigarettes as smoking cessation aids to patients and prescription of nicotine e-liquid. Some GP’s were willing to prescribe nicotine e-liquid for e-cigarettes to patients if other methods of smoking cessation had not worked but there were concerns, and uncertainty, about the safety and efficacy of e-cigarettes for smoking cessation. There was poor understanding of the current policy and legislation about e-cigarettes in Australia. Mostly the GP’s in this sample did not feel confident or comfortable to prescribe, or have discussions about e-cigarettes with patients. Conclusion: Australian GP’s have diverse attitudes on recommending e-cigarettes for smoking cessation and prescribing nicotine e-liquids. Clarity in guidelines and consumer product information are required to enable GP’s to provide consistent and accurate advice to patients that wish to use e-cigarettes as a smoking cessation aid.