Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T07:07:18.587Z Has data issue: false hasContentIssue false

General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey

Published online by Cambridge University Press:  14 May 2020

Gillian Sandra Gould*
Affiliation:
School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales2308, Australia Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales2305, Australia
Simon Chiu
Affiliation:
Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales2305, Australia
Christopher Oldmeadow
Affiliation:
Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales2305, Australia
Yael Bar-Zeev
Affiliation:
School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales2308, Australia
*
Author for correspondence: Gillian Sandra Gould, E-mail: [email protected]

Abstract

Introduction

Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.

Aim

Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.

Methods

National cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).

Results

N = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).

Conclusion

GPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.

Type
Original Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Association of Smoking Cessation Professionals. (2015). Medicare rebates for smoking cessation services. Retrieved August 6, 2016, from http://aascp.org.au/index.php/download_file/view/130/193/Google Scholar
Australian Government Department of Health. (2006). Australian Standard Geographical Classification – Remoteness Area (ASGC-RA 2006). Retrieved January 8, 2020, from https://www.health.gov.au/health-workforce/health-workforce-classifications/australian-statistical-geographical-classification-remoteness-areaGoogle Scholar
Australian Institute of Health and Welfare. (2018). Australia's mothers and babies 2016—in brief. Canberra: AIHW.Google Scholar
Bar-Zeev, Y., Bonevski, B., Gruppetta, M., Twyman, L., Atkins, L., Palazzi, K., … Gould, G. S. (2018 a). Clinician factors associated with prescribing nicotine replacement therapy in pregnancy: A cross-sectional survey of Australian obstetricians and general practitioners. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(3), 366370.CrossRefGoogle ScholarPubMed
Bar-Zeev, Y., Bonevski, B., Twyman, L., Watt, K., Atkins, L., Palazzi, K., … Gould, G. S. (2017 b). Opportunities missed: A cross-sectional survey of the provision of smoking cessation care to pregnant women by Australian general practitioners and obstetricians. Nicotine & Tobacco Research, 19(5), 636641.CrossRefGoogle Scholar
Bar-Zeev, Y., Bovill, M., Bonevski, B., Gruppetta, M., Reath, J., … Gould, G. S. (2017 a). Assessing and validating an educational resource package for health professionals to improve smoking cessation care in Aboriginal and Torres Strait Islander pregnant women. International Journal of Environmental Research and Public Health, 14(10), pii: E1148.CrossRefGoogle ScholarPubMed
Bar-Zeev, Y., Lim, L. L., Bonevski, B., Gruppetta, M., & Gould, G. S. (2018 b). Nicotine replacement therapy for smoking cessation in pregnancy. Medical Journal of Australia, 208(1), 1.CrossRefGoogle Scholar
Bar-Zeev, Y., Skelton, E., Bonevski, B., Gruppetta, M., & Gould, G. S. (2019). Overcoming challenges to treating tobacco use during pregnancy – A qualitative study of Australian general practitioners barriers. BMC Pregnancy and Childbirth, 19(1), 61.CrossRefGoogle ScholarPubMed
Bovill, M., Gruppetta, M., Cadet-James, Y., Clarke, M., Bonevski, B., & Gould, G. S. (2018). Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study. Women and Birth, 31(1), 1016.CrossRefGoogle ScholarPubMed
Carson, K. V., Verbiest, M. E. A., Crone, M. R., Brinn, M. P., Esterman, A. J., Assendelft, W. J. J., … Smith, B. J. (2012). Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews, (Issue 5. Art. No.: CD000214).CrossRefGoogle ScholarPubMed
Coleman, T. (2010). Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework. BMC Public Health, 10, 167167.CrossRefGoogle ScholarPubMed
Dempsey, D., Jacob, P., & Benowitz, N. L. (2002). Accelerated metabolism of nicotine and cotinine in pregnant smokers. The Journal of Pharmacology and Experimental Therapeutics, 301(2), 594598.CrossRefGoogle ScholarPubMed
Gould, G. S., Bittoun, R., & Clarke, M. J. (2015). A pragmatic guide for smoking cessation counselling and the initiation of nicotine replacement therapy for pregnant Aboriginal and Torres Strait Islander smokers. Journal of Smoking Cessation, 10, 96105.CrossRefGoogle Scholar
Gould, G. S., Cadet-James, Y., & Clough, A. R. (2016). Getting over the shock: Taking action on Indigenous maternal smoking. Australian Journal of Primary Health.CrossRefGoogle ScholarPubMed
Gould, G. S., Twyman, L., Stevenson, L., Gribbin, G. R., Bonevski, B., Palazzi, K., … Bar-Zeev, Y. (2019). What components of smoking cessation care during pregnancy are implemented by health providers: A systematic review and meta-analysis. BMJ Open, 9(8), e026037 .CrossRefGoogle ScholarPubMed
Gould, G., Zeev, Y., Tywman, L., Oldmeadow, C., Chiu, S., Clarke, M., … Bonevski, B. (2017). Do clinicians ask pregnant women about exposures to tobacco and cannabis smoking, second-hand-smoke and E-cigarettes? An Australian national cross-sectional survey. International Journal of Environmental Research and Public Health, 14(12), 1585.CrossRefGoogle ScholarPubMed
Groves, R. M., Presser, S., & Dipko, S. (2004). The role of topic interest in survey participation decisions. Public Opinion Quarterly, 68(1), 231.CrossRefGoogle Scholar
Hardy, B., Szatkowski, L., Tata, L. J., Coleman, T., & Dhalwani, N. N. (2014). Smoking cessation advice recorded during pregnancy in United Kingdom primary care. BMC Family Practice, 15, 2121.CrossRefGoogle ScholarPubMed
Harris, B. M., Harris, M. L., Rae, K., & Chojenta, C. (2019). Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: An integrative review. Midwifery, 73, 4961.CrossRefGoogle ScholarPubMed
Mendelsohn, C., Gould, G., & Oncken, C. (2014). Management of smoking in pregnant women. Australian Family Physician, 43, 4651.Google ScholarPubMed
Nulty, D. D. (2008). The adequacy of response rates to online and paper surveys: What can be done? Assessment & Evaluation in Higher Education, 33(3), 301314.CrossRefGoogle Scholar
Passey, M. E., Bryant, J., Hall, A. E., & Sanson-Fisher, R. W. (2013). How will we close in smoking rates for pregnant Indigenous women. Medical Journal of Australia, 199(1), 3941.CrossRefGoogle ScholarPubMed
Passey, M., D'Este, C. A., & Sanson-Fisher, R. (2012). Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: A cross-sectional survey. BMC Public Health, 12, 165.CrossRefGoogle ScholarPubMed
Passey, M. E., Sanson-Fisher, R. W., & Stirling, J. M. (2014). Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: Views of antenatal care providers and pregnant Indigenous women. Maternal and Child Health Journal, 18(10), 22932299.CrossRefGoogle ScholarPubMed
RANZCOG. (2019). RANZCOG gender equity and diversity report. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists.Google Scholar
Rogers, J. M. (2008). Tobacco and pregnancy: Overview of exposures and effects. Birth Defects Research. Part C, Embryo Today: Reviews, 84(1), 115.CrossRefGoogle ScholarPubMed
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. (2014). Women and Smoking (C-Obs 53) Review November 2014. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists.Google Scholar
Templeton, L., Deehan, A., Taylor, C., Drummond, C., & Strang, J. (1997). Surveying general practitioners: Does a low response rate matter? The British Journal of General Practice: the Journal of the Royal College of General Practitioners, 47(415), 9194.Google ScholarPubMed
Wiebe, E. R., Kaczorowski, J., & MacKay, J. (2012). Why are response rates in clinician surveys declining? Canadian Family Physician, 58(4), e225e228.Google ScholarPubMed
Zwar, N. A., & Richmond, R. L. (2006). Role of the general practitioner in smoking cessation. Drug and Alcohol Review, 25(1), 2126.CrossRefGoogle ScholarPubMed
Zwar, N., Richmond, R., Borland, R., Peters, M., Litt, J., Bell, J., … Ferretter, I. (2011 [Updated July 2014]). Supporting smoking cessation: A guide for health professionals. Melbourne: The Royal Australian College of General Practitioners.Google Scholar