Dealing with tobacco use and dependence within primary health care: time for action

Abstract

Main text Primary health care has an operational advantage in overall health promotion, as preventive activities and the management of multimorbidity are placed highly within its agenda. A key component of health promotion is tobacco prevention and smoking cessation, which in the developed world, is the largest preventable cause of death and disability, and estimated to cause 6 million preventable and premature deaths every year [1]. With the above dire number in mind, the World Health Organization has called for smoking cessation to be integrated into primary health care globally [2,3]. Patient centered primary care is seen as the most suitable health system “environment” for providing advice on smoking cessation and general practitioners/family physicians thus have a framework to advocate for smoking cessation within their daily practice [4]. Based on this framework, guidelines have been issued and promoted within primary care practice [4,5]. The first step in handling tobacco control and smoking cessation within daily clinical care is to identify smokers a practice has been shown to increase the likelihood of smokers being provided with help to quit [5], and provide primary care practitioners the chance to refer smokers to a cessation program [6]. Indeed, within the UK, 73% of new patients within primary care were reported to have their smoking status recorded within 90 days of registering an indicator of smoker engagementwith 44% of these entries being recorded on the day of registration [7] The above numbers, although promising, are still far from those that primary care can potentially achieve. Literature frequently reports failure to advise on smoking cessation during clinical visits and this opportunity may be largely missed by clinicians, especially in developing countries or in countries under fiscal constraints [8]. This gap in engagement has been