title: Missed opportunities: general practitioner identification of their patients' smoking status.
abstract: BACKGROUND
  In order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients' use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use.
  
  
  METHODS
  Eligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient's consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use.
  
  
  RESULTS
  Fifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59-73] while specificity was 98% [95% CI 97-98]. Positive predictive value was 78% [95% CI 71-85] and negative predictive value was 96% [95% CI 95-97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded 'Other' were less likely to be detected as smokers than patients who had completed a high school or below level of education.
  
  
  CONCLUSIONS
  Despite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient's smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.
authors: Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia. Jamie.bryant@newcastle.edu.au.
authors: Jamie
authors: J
authors: Bryant
authors: Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia. Mariko.carey@newcastle.edu.au.
authors: Mariko
authors: M
authors: Carey
authors: Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia. Rob.Sanson-Fisher@newcastle.edu.au.
authors: Rob
authors: R
authors: Sanson-Fisher
authors: Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia. elise.mansfield@newcastle.edu.au.
authors: Elise
authors: E
authors: Mansfield
authors: Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia. tim.regan@newcastle.edu.au.
authors: Tim
authors: T
authors: Regan
authors: Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia. Alessandra.Bisquera@newcastle.edu.au.
authors: Alessandra
authors: A
authors: Bisquera
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation
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