Smoking cessation and counseling: practices of Canadian physical therapists.
Although engaging or supporting smoking cessation with patients is a health priority for health professionals, the degree to which physical therapists do so is unknown. They have a particular responsibility given their professional commitment to patient education, and typical practice pattern (i.e., long, multiple visits).
This study examined the smoking-cessation practices of Canadian physical therapists, including the frequency of such counseling; use of the established 5A's approach (ask, advise, assist, assess, and arrange follow-up); and smoking-cessation training received.
A cross-sectional postal survey of licensed practicing physical therapists in Canada was conducted. Surveys were mailed between April and June 2009 and data analyzed in November 2009. Descriptive statistics characterized their sociodemographics and counseling practices; chi-square assessed differences between those trained in smoking-cessation counseling trained and those untrained for the 5A's, and regional differences for smoking- cessation counseling frequency and training.
Completed surveys (n=738) yielded a 78.1% response rate. Most physical therapists (54.0%) counsel rarely or not at all. Regional differences for smoking-cessation counseling were observed. In all, 76.3% asked their patients if they smoke, but few (21.6%) reported assisting their patients to quit smoking. Few reported receiving smoking-cessation counseling training; proportionally, those trained in smoking-cessation counseling assisted, assessed, and arranged follow-ups more than those who were untrained.
Few Canadian physical therapists (25.4%) counsel for smoking cessation all or most times, or adhere to the established 5A's approach. Smoking-cessation counseling training including the 5A's needs to be included in physical therapy continuing education and the curricula in entry-level programs, consistent with 21st-century health priorities.
Bodner ME
，Rhodes RE
，Miller WC
，Dean E
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Opportunities Missed: A Cross-Sectional Survey of the Provision of Smoking Cessation Care to Pregnant Women by Australian General Practitioners and Obstetricians.
Similar to other high-income countries, smoking rates in pregnancy can be high in specific vulnerable groups in Australia. Several clinical guidelines exist, including the 5A's (Ask, Advice, Assess, Assist, and Arrange), ABCD (Ask, Brief advice, Cessation, and Discuss), and AAR (Ask, Advice, and Refer). There is lack of data on provision of smoking cessation care (SCC) of Australian General Practitioners (GPs) and Obstetricians.
A cross-sectional survey explored the provision of SCC, barriers and enablers using the Theoretical Domains Framework, and the associations between them. Two samples were invited: (1) GPs and Obstetricians from a college database (n = 5571); (2) GPs from a special interest group for Indigenous health (n = 500). Dimension reduction for the Theoretical Domains Framework was achieved with factor analysis. Logistic regression was carried out for performing all the 5A's and the AAR.
Performing all of the 5A's, ABCD, and AAR "often and always" was reported by 19.9%, 15.6%, and 49.2% respectively. "Internal influences" (such as confidence in counselling) were associated with higher performance of the 5A's (Adjusted OR 2.69 (95% CI 1.5, 4.8), p < .001), whereas "External influences" (such as workplace routine) were associated with higher performance of AAR (Adjusted OR 1.7 (95% CI 1, 2.8), p = .035).
Performance in providing SCC to pregnant women is low among Australian GPs and Obstetricians. Training clinicians should focus on improving internal influences such as confidence and optimism. The AAR may be easier to implement, and interventions at the service level should focus on ensuring easy, effective, and acceptable referral mechanisms are in place.
Improving provision of the 5A's approach should focus on the individual level, including better training for GPs and Obstetricians, designed to improve specific "internal" barriers such as confidence in counselling and optimism. The AAR may be easier to implement in view of the higher overall performance of this approach. Interventions on a more systemic level need to ensure easy, effective, and acceptable referral mechanisms are in place. More research is needed specifically on the acceptability of the Quitline for pregnant women, both Indigenous and non-Indigenous.
Zeev YB
，Bonevski B
，Twyman L
，Watt K
，Atkins L
，Palazzi K
，Oldmeadow C
，Gould GS
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