title: Smoking cessation in primary care: Exploration of barriers and solutions in current daily practice from the perspective of smokers and healthcare professionals.
abstract: BACKGROUND
  Evidence based recommendations for smoking cessation are not followed in routine primary care. A better understanding is needed why smoking cessation treatment is still underutilized.
  
  
  OBJECTIVE
  To explore barriers and solutions of smoking cessation treatment, from the perspective of smokers and healthcare professionals in Dutch primary care.
  
  
  METHODS
  Focus groups were conducted with 14 smokers (smokers and ex-smokers) and semi-structured individual interviews with nine healthcare professionals (general practitioners and practice nurses). Data was analysed using the Constant Comparative Method.
  
  
  RESULTS
  Barriers that prevented successful smoking cessation treatment were the lack of awareness regarding the available smoking cessation treatments at the healthcare centre among smokers and the resistance against preventive tasks among healthcare professionals. Nonetheless, general practitioners (GPs) did not fear jeopardizing the doctor-patient relationship by discussing smoking. Quitting was regarded as the smokers' own responsibility and GPs felt that merely using medication was no guarantee for successful quitting. Even so, practice nurses and smokers preferred medication use. Proposed solutions were that GPs should advise smokers to quit, whereas someone else should deliver intensive behavioural support, preferably the practice nurse.
  
  
  CONCLUSIONS
  Smokers and healthcare professionals seem to wait for each other to start smoking cessation. GPs should know that they could discuss smoking cessation with every patient without jeopardizing the doctor-patient relationship, preferably followed by referral to a practice nurse for intensive behavioural support. Furthermore, more patients should know that they could receive pharmacological treatment as well as behavioural support for smoking cessation in their healthcare centre.
authors: CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht , the Netherlands.
authors: Carolien
authors: C
authors: van Rossem
authors: Mark G
authors: MG
authors: Spigt
authors: Jolien R C
authors: JR
authors: Kleijsen
authors: Melanie
authors: M
authors: Hendricx
authors: Constant P
authors: CP
authors: van Schayck
authors: Daniel
authors: D
authors: Kotz
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018722:Nicotinic Agonists / Q000627:therapeutic use; D009726:Nurses / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D016540:Smoking Cessation / Q000379:methods; D061485:Tobacco Use Cessation Devices
chemical_list: D018722:Nicotinic Agonists
keywords: Smoking cessation; general practitioner; practice nurse; primary care; qualitative research