Förderung der Tabakabstinenz in der hausärztlichen Praxis: Die aktuelle Situation in Deutschland

AIM: Screening and counselling for tobacco smoking in general practices should be enhanced because there is a high degree utilisation of general practices in Germany and brief interventions have shown their efficacy. There are clinical guidelines for smoking cessation, but they are implemented insufficiently. General practitioners feel responsible for prevention, but the lack of systematic screening as well as advising patients on smoking cessation on a routine basis is evident. The aim of this study is 1st) to review the state of research of brief interventions enhancing tobacco abstinence in general practices, 2nd) to investigate the frequency and conditions of addressing smoking in a representative sample of patients in the general practice and 3rd) to introduce innovative approaches that are promising to improve the current situation. METHODS: Patients of a random sample of 34 general practices (participation rate 87%) in Western Pomerania were screened consecutively. 2016 fulfilled the inclusion criteria of being a smoker between 18 and 70 years of age, from which informed consent for study participation was obtained by 1653 (82%). The present analyses is based on patients that have been visiting the same general practice for more than one year (N=1066). Patients answered a questionnaire in the waiting room. RESULTS: A proportion of 42% reported ever having been addressed towards their smoking behaviour by their general practitioner. Considering the previous 12 months the proportion was 27%. There was a difference between those patients and patients not having been addressed during the previous 12 months indicating that addressed patients were older, smoked more cigarettes per day and were more dependent. The frequency of males, having a quit attempt during the last 12 months, and using smoking cessation aids during the last 12 months was higher in this group. Logistic regression analysis including all important univariate variables confirmed all recovered associations but number of cigarettes smoked per day. CONCLUSION: Clinical practice guidelines for smoking cessation are only realised for every fourth smoker when looking at the suggestion to provide an advice to stop smoking at least once a year. Our analysis indicates that probably those smokers are addressed in which the negative consequences of smoking are more obvious. The counselling situation in general practices could be improved by training in motivational conversation techniques, involvement of the praxis team or usage of recall aids.