Australian GP's and Obstetrician management of smoking in pregnant women: where do we need to intervene?

Introduction: Several approaches to the management of smoking in pregnancy exist, including the 5As (Ask, Advice, Assess, Assist, Arrange); and the AAR (Ask, Advice, Refer). There is lack of data on current practices of Australian physicians, which would help guide the development of interventions for improving smoking cessation care (SCC) in pregnancy. Methods: A national cross-sectional survey including questions about the provision of SCC; Nicotine Replacement Therapy (NRT) prescription; and a self-assessment of barriers using the Theoretical Domains Framework (TDF). We included two sampling methods:1). A paper survey sent to 5571 Australian General Practitioners(GP’s) and Obstetricians from the Royal Australian and New Zealand College of Obstetricians and Gynecologists database, and2). An online survey sent to a random sample of 500 Members of the Royal Australian College of GP’s National Faculty of Aboriginal and Torres Strait Islander Health. Results: A total of 378 responded. Performing all the 5A’s often and always was reported by 19.9%; and 49.1% for AAR’. Obstetricians performed the 5A’s less reliably compared to GP’s (p<0.001). Always prescribing NRT was reported by 11%. The lowest mean TDF scores were for lack of resources (time) and optimism. Conclusions: Performance of SCC is low. Training clinicians should focus on improving the provision of specific lacking components, such as NRT prescription, and incorporate strategies to change attitudes such as lack of optimism. The AAR approach may be easier to implement, and therefore it should be a priority to ensure easy, effective and acceptable referral mechanisms are in place.