Missed opportunities for brief intervention in tobacco control in primary care: patients' perspectives from primary health care settings in India.

ABSTRACT

BACKGROUND: World Health Organization has called for tobacco cessation to be integrated into primary care. Primary Health Centres (PHC) offer opportunities for tobacco-use screening and brief cessation advice but data on such activities in developing countries such as India are limited. The aim of this study was to investigate screening and brief intervention practices of health service providers in primary care. METHODS: This cross-sectional study was conducted in 2012 among 1,549 patients aged over 18 years visiting PHCs in 12 districts of two Indian states- Andhra Pradesh and Gujarat. Responses were collected using an interviewer-administered questionnaire. Information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised to quit tobacco use. The primary outcome was whether patients were screened during their visit to the PHC. Data analysis was performed using multi-level logistic regression. RESULTS: Less than one-third (447) of patients were screened for tobacco use during their visit to the PHC. People presenting with respiratory complaints were 84% more likely (OR 1.84; 95% CI 1.30 to 2.62) to be screened for tobacco use when compared to those with general ailments. Number of quit attempts in the past 12 months was strongly associated with the outcome of being screened for tobacco use, indicating that people who had more than 5 quit attempts were two times more likely to be screened for tobacco use than those who had never attempted to quit tobacco (OR 1.99; 95% CI 1.03 to 3.8). Among the 447 patients who were screened for tobacco use, only 136 reported to have been counselled and merely 67 patients received suggestions on ways to quit tobacco. CONCLUSION: Our results show that opportunities for screening and providing tobacco use cessation advice were largely missed by the health service providers. Our study suggests that there is an urgent need to incorporate tobacco cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and counselling to quit tobacco.