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Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

2014; Nature Portfolio; Volume: 24; Issue: 1 Linguagem: Inglês

10.1038/npjpcrm.2014.22

2055-1010

Cătălina Panaitescu, Mandy Moffat, Siân Williams, Hilary Pinnock, Melinda Boros, Cristian Sever Oană, Sandra Alexiu, Ioanna Tsiligianni,

Global Public Health Policies and Epidemiology

Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients' inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption. Family doctors in Romania need further professional training and increased resources to help patients stop smoking. Despite increased legislation to help reduce tobacco-related diseases in Romania, few people are given advice and assistance to quit smoking by their family doctors. In order to pinpoint reasons for this, Catalina Panaitescu at the Family Medicine Solo Practice in Bucharest, together with researchers across Romania and in the UK, carried out a qualitative study comprising semi-structured interviews and focus group discussions with 41 family doctors in Bucharest and rural areas within 600 km of the city. Many of the doctors interviewed preferred to send patients to specialists, and appeared to be influenced by the country's hierarchical social and health-care system. A lack of time in consultations, a need for better training and resources and worries about costs to patients were also key concerns.