چکیده (انگلیسی):

Background:In order to provide smoking cessation support to their patients in line with clinical practice
guidelines, general practitioners must first ascertain whether their patients’ use tobacco. This study examined (i) the
sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of
smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use.
Methods:Eligible patients completed a touchscreen computer survey while waiting for an appointment with their
general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status.
Following the patient’s consultation, their general practitioner was asked to indicate whether the patient was a
current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value
and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking
status as the gold standard. Generalised estimating equations were used to examine the general practitioner and
patient characteristics associated with detection of tobacco use.
Results:Fifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of
smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner
assessment was 66% [95% CI 59–73] while specificity was 98% [95% CI 97–98]. Positive predictive value was 78%
[95% CI 71–85] and negative predictive value was 96% [95% CI 95–97]. No general practitioner factors were associated
with detection of smoking. Patients with ahigher level of education or who responded‘Other’ were less likely to
be detected as smokers than patients who had completed a high school or below level of education.
Conclusion:Despite the important role general practitioners play in providing smoking cessation advice and support,
a substantial proportion of general practitioners do not know their patient’s smoking status. This represents a significant
missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general
practitioners in improving the identification of smokers.