Direct observation of smoking cessation activities in primary care practice

• Published in: The Journal of family practice Vol. 50; no. 8; pp. 688 - 693
• Main Authors: Ellerbeck, E F, Ahluwalia, J S, Jolicoeur, D G, Gladden, J, Mosier, M C
• Format: Journal Article
• Language: English
• Published: United States Jobson Medical Information LLC 01-08-2001
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Attitude of Health Personnel; Care and treatment; Family Practice - education; Family Practice - organization & administration; Female; Health Knowledge, Attitudes, Practice; Health Services Research; Humans; Kansas; Male; Medical Records; Middle Aged; Office Visits; Patient Education as Topic - methods; Patient Education as Topic - statistics & numerical data; Physician and patient; Physicians, Family - education; Physicians, Family - psychology; Practice Patterns, Physicians' - statistics & numerical data; Primary Health Care - organization & administration; Sex Factors; Smoking Cessation - methods; Smoking Cessation - statistics & numerical data; Smoking cessation programs; Tobacco habit; Kansas; United States
• ISSN: 0094-3509

Our goals were to determine how often family physicians incorporate smoking cessation efforts into routine office visits and to examine the effect of patient, physician, and office characteristics on the frequency of these efforts.
Data was gathered using direct observation of physician-patient encounters, a survey of physicians, and an on-site examination of office systems for supporting smoking cessation.
We included patients seen for routine office visits in 38 primary care physician practices.
The frequency of tobacco discussions among all patients, the extent of these discussions among smokers, and the presence of tobacco-related systems and policies in physicians' offices were measured.
Tobacco was discussed during 633 of 2963 encounters (21%; range among practices = 0%-90%). Discussion of tobacco was more common in the 58% of practices that had standard forms for recording smoking status (26% vs 16%; P=.01). Tobacco discussions were more common during new patient visits but occurred less often with older patients and among physicians in practice more than 10 years. Of 244 smokers identified, physicians provided assistance with smoking cessation for 38% (range among practices = 0%-100%). Bupropion and nicotine-replacement therapy were discussed with smokers in 31% and 17% of encounters, respectively. Although 68% of offices had smoking cessation materials for patients, few recorded tobacco use in the "vital signs" section of the patient history or assigned smoking-related tasks to nonphysician personnel.
Smoking cessation practices vary widely in primary care offices. Strategies are needed to assist physicians with incorporating systematic approaches to maximize smoking cessation rates.