General practitioners' role in preventive medicine: scenario analysis using smoking as a case study.

AIM: It is the purpose of this paper to develop a model which may be used in conjunction with scenario analysis to evaluate strategies which are available to assist the general practitioner (GP) in reducing smoking behaviour among their patients. DESIGN: The scenario analysis uses a four-step procedure which involves identifying opportunities for detection, intervention and efficacy, and assigning probabilities to outcome to enable a range of prevention strategies to be examined in both isolation and in combination. SETTING AND PARTICIPANTS: This study deals specifically with Australian general practice and the model is derived by using information for a smoker visiting their GP within a 6-month period together with empirical evidence on the rates of detection, intervention and efficacy. MEASUREMENTS: The outcome measures, which are evaluated in terms of marginal effectiveness, include the number of smoking patients detected, the number of smoking patients offered an intervention, the number of smoker patients who quit as a result of the intervention and the additional years of life saved due to an intervention. FINDINGS. The most significant indicator for reducing smoking rates among patients is improving the efficacy of interventions. The results also suggest that although improvements in the rate of GP detection of patients' smoking status have a potentially greater effect on quit rates than increasing intervention levels, increasing both detection and intervention levels had a greater effect than each strategy alone. DISCUSSION: : General practitioners have an important role to play in preventive medicine. The knowledge, skill and attitude of practitioners toward smoking are significant, and they can be the prime motivators is persuading their patients to stop smoking. Detection, intervention and efficacious strategies are all key elements in achieving this result.