GENERAL-PRACTITIONERS ROLE IN PREVENTIVE MEDICINE - SCENARIO ANALYSISUSING SMOKING AS A CASE-STUDY

Aim. It is the purpose of this paper to develop a model which may be u sed in conjunction with scenario analysis to evaluate strategies which are available to assist the general practitioner (GP) in reducing smo king behaviour among their patients. Design. The scenario analysis use s a four-step procedure which involves identifying opportunities for d etection, intervention and efficacy, and assigning probabilities to ou tcomes to enable a range of prevention strategies to be examined in bo th isolation and in combination. Setting and participants. This study deals specifically with Australian general practice and the model is d erived by using information for a smoker visiting their GP within a 6- month period together with empirical evidence on the rates of detectio n, intervention and efficacy. Measurements. The outcome measures, whic h are evaluated in terms of marginal effectiveness, include the number of smoking patients detected, the number of smoking patients offered an intervention, the number of smoker patients who quit as a result of the intervention and the additional years of life saved due to an int ervention. Findings. The most significant indicator for reducing smoki ng rates among patients is improving the efficacy of interventions. Th e results also suggest that although improvements in the rate of GP de tection of patients' smoking status have a potentially greater effect on quit rates than increasing intervention levels, increasing both det ection and intervention levels had a greater effect than each strategy alone. Discussion. General practitioners have an important role to pl ay in preventive medicine. The knowledge, skill and attitude of practi tioners toward smoking are significant, and they can be the prime moti vators in persuading their patients to stop smoking. Detection, interv ention and efficacious strategies are all key elements in achieving th is result.