Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessationReport as inadecuate




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BMC Health Services Research

, 10:121

First Online: 12 May 2010Received: 07 September 2009Accepted: 12 May 2010DOI: 10.1186-1472-6963-10-121

Cite this article as: Tønnesen, H., Faurschou, P., Ralov, H. et al. BMC Health Serv Res 2010 10: 121. doi:10.1186-1472-6963-10-121

Abstract

BackgroundDaily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients- preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner-s GP referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway.

MethodsThe design was an exploratory prospective trial. The outcome measured was the number of patients referred to a preoperative smoking and alcohol cessation programme at the same time as being referred for elective surgery by their GP. The participants consisted of 72 high-risk patients who were referred for elective surgery by 47 local participating GPs.

The GPs, nurses, and specialists in internal medicine, prehabilitation and surgery developed new clinical practice guidelines based on the literature and interviews with 11 local GPs about the specific barriers for implementing a smoking and alcohol cessation programme. The role of the GP was to be the gatekeeper: identifying daily smokers and hazardous drinkers when referring them to surgery; handing out information on risk reduction; and referring those patients identified to a preoperative smoking and alcohol cessation programme. The role of the hospital was to contact these patients to initiate smoking and alcohol cessation at the hospital out-patient clinic for life-style intervention.

ResultsThe GPs increased their referral to the smoking and alcohol cessation programme from 0% to 10% 7-72 patients in the study period.

ConclusionThe effect of the study was limited in integrating the efforts of primary care providers and hospital surgical departments in increasing the up-take of preoperative smoking and alcohol cessation programmes aimed at smokers and harmful drinkers referred for surgery. New strategies for cooperation between GPs and surgical departments are urgently needed.

Trial registrationJ.nr. 2005-54-1781 in Danish Data Protection Agency.

J.nr. 07 268136 in Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-10-121 contains supplementary material, which is available to authorized users.

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Author: Hanne Tønnesen - Pernille Faurschou - Helge Ralov - Ditte Mølgaard-Nielsen - Grethe Thomas - Vibeke Backer

Source: https://link.springer.com/







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