Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia

Physician Reluctance to Intervene in Addiction: A Systematic Review

Importance

The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.

Objective

To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.

Data Sources

A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.

Study Selection

Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.

Data Extraction and Synthesis

Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.

Main Outcomes and Measures

The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.

Results

A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.

Conclusions and Relevance

In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia

Background. Healthcare workers (HCWs) can play a signifi- cant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke. Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia. Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated. Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs- based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) sys- tem-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC. Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the deliv- ery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.

Knowledge, Attitudes and Practices of Primary Care Physicians Regarding Tobacco Dependence Treatment in Muscat Governorate, Oman: A cross-sectional study

Objectives

This study aimed to assess the knowledge, attitudes and practices (KAPs) of primary care physicians (PCPs) regarding tobacco dependence treatment (TDT) and to identify barriers to TDT practice in Muscat, Oman.

Methods

This cross-sectional study was carried out from September 2019 to December 2019 at all 27 health centres in Muscat. All 313 PCPs working in these health centres were invited to participate. An adapted version of a previously validated 36-item questionnaire was used to assess KAPs regarding TDT services.

Results

A total of 255 PCPs completed the survey (response rate: 81.5%) and they demonstrated poor knowledge (40%) but positive attitudes (60%) about TDT services. Of these, the majority were female (85.9%), had never smoked (99.2%) and were general practitioners (64.3%). The mean age was 34.3 ± 6.3 years. Only 28.2% had previously received TDT training and less than half displayed accurate TDT-related knowledge, with undergraduate medical school representing the main source of such knowledge (58.8%). While 96.9% of the PCPs agreed on the importance of TDT, only 28.6% reported feeling sufficiently confident to provide such services themselves. Lack of training (83.5%) and time (71.4%) were the main barriers to TDT practice.

Conclusion

Overall, PCPs in Muscat demonstrated poor knowledge but positive attitudes with regard to TDT; however, further knowledge and training is required in order to ensure the effective and accurate provision of TDT services. These findings provide baseline data which may be of value for further research and in overcoming barriers to TDT practice in Oman; for instance, establishing cessation services as part of the package of care in primary health centres could address the time constraints barriers identified by the PCPs.

When primary care providers and smokers meet: a systematic review and metasynthesis

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Knowledge, attitudes, practice and barriers of physicians to provide tobacco dependence treatment: a cluster analysis

INTRODUCTION

in Oman, there is a need to understand the profile of primary care physicians' (PCP) knowledge, attitude, and practice, and barriers (KAPB) towards tobacco dependence treatment (TDT). Their profile will directly affect their consultation and contribution to health care educators to develop an appropriate educational program for the PCPs. The aim of this study is to determine profiles in a cohort of PCP with regards to factors associated with physicians' perceived KAPB of providing TDT.

METHODS

a cross-sectional survey was conducted for four months from September to December 2019. A sample of 226 (response rate is 71.2%) PCPs working for Muscat's health centers, the capital of Oman, was collected. A 2-step cluster method was used to separate the sample into sub-groups according to their demographic and KAPB scores.

RESULTS

cluster analysis revealed two groups of PCPs who are different in demographics and KAPB scores. The PCPs in cluster B (27.4%) have higher educational levels, senior ranking, more males and older. They labeled as the "good knowledge, positive attitudes, and highly practices" group. The PCPs in cluster A comprised 72.6% of our samples. There are more females, younger, and with a junior ranking. This cluster was identified as the "lack of knowledge, moderate attitudes, and rarely practices" group.

CONCLUSION

findings might help primary health care authorities to address this preventable issue and plan interventions to establish well-structured TDT clinics in the future.

Violation of the Global Ceasefire in Nagorno-Karabagh: A Viral Amplification of Aggression

On March 23, 2020, the United Nations (UN) made an "Appeal for a Global Ceasefire following the Outbreak of Coronavirus." Despite this appeal, the Nagorno-Karabagh war was instigated on September 27, 2020. This Guest Editorial frames the conflict in the context of the UN appeal and by introducing a figure that plots seven-day average coronavirus disease 2019 (COVID-19) cases overlaid with key inflection points to illustrate the clear impact that conflict has had on pandemic spread in Armenia. The conflict in Nagorno-Karabagh provides a timely, concise, and illustrative example of conflict and its impact on health. Finally, an argument is made that the ability to enforce the UN "Appeal for a Global Ceasefire" is essential to ensure global health and security.

Doctors' smoking control knowledge, attitudes and practices: a cross-sectional study conducted in Shandong Province, China

Background

Doctors play an important role in smoking control. This study aimed to assess doctors’ smoking control knowledge, attitudes and practices to help doctors raise awareness of smoking control assistance.

Methods

This cross-sectional study recruited 1046 doctors from Shandong Province, China, by using multistage sampling. Participants’ information was collected by questionnaire. Pearson’s χ² test and Fisher’s exact probability method were used to compare the distributions of categorical variables between/among groups.

Results

Among the participants, 14.7% were current smokers. Approximately 50.3% of participants had heard of smoking cessation drugs and 59.2% of participants thought that low-tar and low-nicotine cigarettes were as harmful to health as common cigarettes. Approximately 98.2 and 60.9% of participants agreed that smoking was related to lung cancer and male sexual dysfunction, respectively. Although 72.0% of participants believed that doctors should actively provide smoking cessation assistance, only 58.1% of participants considered that doctors should be responsible for providing smoking cessation assistance. Similarly, 85.2% of participants often asked about the smoking history of patients or their family members, while only 4.9% of participants had prescribed smoking cessation drugs for patients. Pediatricians had a higher proportion of “Agree” responses to the assessment items than doctors in other departments.

Conclusions

The results showed that doctors in Shandong Province did not have sufficient knowledge of smoking control. Slightly more than half of doctors thought that providing smoking cessation assistance was their responsibility. Only a few participants had prescribed smoking cessation drugs.

Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study

INTRODUCTION

Smoking cessation interventions within tuberculosis (TB) care are feasible, effective and efficient for increasing smoking cessation rates. We aimed to assess TB physicians’ smoking cessation knowledge, attitude, and practices (KAP).

METHODS

We conducted a qualitative study with 21 TB physicians and utilized directed deductive content analysis with predefined knowledge, attitude, and practice categories. Physicians’ practice was analyzed using the ABC approach (Ask, Brief advice, and Cessation support).

RESULTS

Physicians acknowledged the importance of quitting for improved treatment outcomes and decreased risk of TB relapse. Physicians revealed presumed drug interactions, possible side effects of pharmacotherapy, and reluctance to take additional medications as challenges of smoking cessation interventions. Physicians asked about smoking behavior and provided a brief quitting advice to TB patients; however, implementation of cessation support was limited due to poor knowledge of evidence-based cessation methods and the absence of formal tobacco dependence treatment algorithms within TB care.

CONCLUSIONS

TB physicians’ KAP on smoking cessation was limited. Interventions targeting physicians’ knowledge and skills, and formalization of tobacco dependence treatment within TB care, are core for improving their smoking cessation practices in Armenia.

Barriers to utilization of adolescent friendly health services in primary healthcare facilities in Armenia: a qualitative study

OBJECTIVES

The study aimed to explore potential challenges that hamper utilization of adolescent friendly health services (AFHS) in primary healthcare (PHC) facilities in Armenia.

METHODS

A qualitative study using in-depth interviews and focus group discussions was conducted with experts in adolescent health, PHC providers and facility managers from public PHC facilities and adolescents from the two largest cities in Armenia. We also collected data through observations in PHC facilities. We utilized a directed content analysis approach for data analysis.

RESULTS

The study identified various factors negatively influencing utilization of AFHS in Armenia. These factors included adolescents' poor health literacy and awareness of health services, lack of PHPs' professional competencies, and breaches of confidentiality. Several facility-level barriers such as lack of privacy, inconvenient operating hours and long waiting times also contributed to insufficient service utilization by adolescents.

CONCLUSIONS

The study findings shed light on different perspectives related to various challenges adolescents faced in PHC facilities in Armenia. Targeted interventions needed to improve adolescents' health literacy, to enhance the PHPs' competencies and to create a friendly and welcoming environment in PHC facilities.