Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review.
BACKGROUND
Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be.


OBJECTIVE
This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement.


METHODS
Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills.


RESULTS
The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation.


CONCLUSIONS
Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe.
Stead
Martine
M
Institute for Social Marketing, University of Stirling and The Open University, Stirling FK94LA. martine.stead@stir.ac.uk
Angus
Kathryn
K
Holme
Ingrid
I
Cohen
David
D
Tait
Gayle
G
D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D005060:Europe; D005194:Family Practice / Q000191:economics; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D010817:Physician-Patient Relations; D011364:Professional Practice / Q000191:economics; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*
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