Analysis of the Current Status and Influencing Factors of brief intervention for smoking cessation in Primary Healthcare Facilities Based on the Unannounced Standardized Patient Approach

Background: Brief intervention for smoking cessation (BISC) is an evidence-based intervention measure. Evaluating the current status of physicians' implementation of BISC is a prerequisite for improving their execution. However, previous studies have relied on traditional questionnaire surveys, which have limitations in terms of objectivity and accuracy. This study aims to objectively and accurately evaluate the implementation of BISC by physicians in primary healthcare facilities using the approach of unannounced standardized patient (USP) visits. Methods: This study used unannounced standardized patient (USP) to survey 1,226 primary care in seven provinces in China from March 2021 to December 2022. Based on the per capita economic burden of smoking-related diseases, incidence rates, population attributable fraction, per capita treatment costs, and the number of smokers that could be reduced at different implementation rates of BISC, estimated the benefit of BISC. Results: Even with a BISC implementation rate of only 20%, the number of smokers could still be reduced by 6.29 million, and the direct economic burden of diseases could be decreased by 195.3 billion dollars. The implementation rate of BISC by physicians was only 3.6%. Outpatient departments/clinics, as well as physicians in Shaanxi province, were more likely to implement BISC. Conclusion: The implementation rate of BISC in Chinese primary healthcare facilities is low, and physicians demonstrate differential treatment toward patients.