Identified Barriers | Present efforts to overcome the barriers |
---|---|
Fear of infringing the patient's right to self-determination [32] | Information regarding smoking and harmful drinking as objective risk factors for surgery and of the risk-reduction programmes (according to the patient folder) respecting the patient's right to self-determination on informed basis. |
Missed the opportunity for promotion of medical benefit and protections from harm (i.e. GPs only engage with patients with smoking-related problems) [23, 32, 33] | Focus on the evidence of risk-reduction in relation to the current surgical illness |
GP limited consultation to addressing patient's agendas relating to surgery [23, 24, 33, 34] | Focus on the evidence of the high-risks of surgery for smokers and harmful drinkers. Systematic approach to identify and intervene |
Harming the relationship with the patient [32] | Dissemination of knowledge that the majority of patients expect the GP and the hospital to deal with lifestyle. Use of the surgical illness as a window of opportunity to offer intervention |
Only including engaged GPs, who volunteer to participate after informed consent. Focus on the GPs as key persons to initiate the risk reduction programmes in due time prior to surgery. | |
The extra workload for the GP was less than 5 minutes per referred high-risk patient for surgery. The resulting increase of the reimbursement was 1/3 for the specific consultation | |
Simplified the information material, referring process, and guidelines which were to be handled by the GPs | |
Distribute knowledge about the high effectiveness of preoperative smoking and alcohol intervention (60-90% quitters) | |
Shortage of smoking cessation experts to whom the patient could be referred to [23, 25, 28, 30] | Easy access by telephone-answering-machine to smoking cessation expertise, who took over the contact with the smokers and harmful drinkers once referred |
Anticipating patient's lack of motivation and interest [26, 28, 29] | Distribute knowledge that the majority of patients expect the GP and the hospital to deal with lifestyle. Use of the surgical illness as a window of opportunity to offer intervention |