Tobacco use is the leading cause of death in the US, with smoking responsible for more than 440,000 deaths each year. Calling it quits is not easy to do, but many people who smoke don’t get adequate treatment for their tobacco use.
National guidelines put out by the Agency for Healthcare Research and Quality (AHRQ) recommend that all clinicians advise their patients who use tobacco to quit. However data suggests that most smokers are not offered support to help them quit, or even advised to quit, during a visit to their doctor.
A new study in the April 21, 2004 issue of the
Journal of the National Cancer Institute
found that people are more likely to quit smoking when their primary care clinician uses guideline-based methods to help their patients succeed.
About the Study
This study included 2163 adults who smoked at least one cigarette per day and visited one of eight primary care clinics in southern Wisconsin. The researchers randomly selected four of these sites to be test intervention sites, and the other four to be control sites.
At the control sites, the researchers provided staff with general information on the AHQR guidelines. But at the test sites, the researchers worked with intake clinicians (nurses and medical assistants who document the reason for an office visit and check a patients’ vital signs) to implement the AHQR guidelines. The test intervention included the following components:
Instructing clinicians on how to assess a patient’s smoking status and provide a brief smoking cessation message to each patient
Stamping patient forms to remind clinicians to perform the guideline-recommended actions
Providing telephone counseling and/or nicotine patches for patients who expressed a willingness to quit smoking within 30 days
Assessing clinician performance through group and individual interviews with the patients
Study personnel conducted telephone interviews to follow-up with patients about their smoking status at two and six months after their visit. The researchers then compared clinician performance and patient smoking status at the two sites.
The overall finding was that test site clinics were more likely to adhere to the recommended guidelines, and that their patients were more likely to quit smoking.
Seventy-three percent of the clinicians at the test sites asked about their patients’ willingness to quit smoking, compared to 30% at control sites. And 27% of the clinicians at the test sites assisted their patients with setting a date to quit smoking, compared to 1% at the control sites.
A total of 183 participants at the test sites received additional intervention after they indicated they were willing to quit within 30 days. Of these participants, 81% completed at least one session of telephone counseling and 90% received nicotine replacement therapy.
Participants at the test sites were more likely than those at the control sites to report abstinence from smoking at the two-month follow-up interview (16% versus 6%) and the six-month follow-up interview (11% versus 4%). Participants who received both nicotine replacement therapy and counseling were the most likely to quit smoking.
How Does This Affect You?
This study suggests that with adequate training and staff, primary care clinics can successfully incorporate smoking cessation guidelines and reduce smoking rates among their patients. Furthermore it highlights the unique and important opportunity that primary care clinics have to encourage smoking cessation.
Today, physicians and nurses alike generally have little time to spend with their patients, which is one reason why they often forgo attempts to help their patients quit smoking. But this study shows that an effective intervention doesn’t need to rest all in the hands of the physician, and can be completed in as little as two to three extra minutes. Just as importantly, it shows that encouraging patients to quit smoking does pay off, and should not be viewed as a waste of time. Even though 11% may not seem very impressive, applying this quit rate nationwide would mean about 500,000 fewer smokers.
Given that 70% of people who smoke visit a physician each year, clinic-based smoking interventions are an efficient way to reach smokers. Primary care clinics and managed care organizations, therefore, should consider implementing standardized guidelines to help smokers quit. If successful, the investment could substantially reduce health care costs, particularly over the long-term.
If you smoke and are ready to quit, talk to your doctor. He or she can provide you with nicotine patches, counseling, and other resources to help you give up and stay off cigarettes. Changing a health behavior like smoking is never easy. Apparently, though, your doctor’s office may be the best place to start.
Katz DA, Muehlenbruch DR, Brown RL, Fiore MC, Baker TB. Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial.
. 2004; 96(8): 594-603.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of Death in the United States, 2000.
. 2004; 291(10): 1263-1264.
Schnoll RA, Engstrom PF. Tobacco Control in the Physician’s Office: A Matter of Adequate Training and Resources.
. 2004; 96(8): 573-575.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a