Training intake clinicians at primary care facilities to use specific, guideline-based methods to encourage their patients who smoke to quit increases the likelihood that their patients will successfully quit smoking, according to a study published in the April 21 issue of the Journal of the National Cancer Institute. Intake clinicians are nurses and medical assistants who document the reasons for an office visit and check patients' vital signs.
In 1996 (and updated in 2000), the Agency for Healthcare Research and Quality (AHRQ) released its Smoking Cessation Clinical Practice Guideline, which recommends that all clinicians strongly advise patients who smoke to quit and instructs them in methods to help their patients successfully quit. Many physicians, however, do not advise their patients to stop smoking because they do not believe it will work. In addition, physicians may lack the time and personnel to provide their patients with assistance for smoking cessation.
To study the effectiveness of the AHRQ Guideline, David A. Katz, M.D., M.Sc., formerly of the University of Wisconsin-Madison, and colleagues conducted a randomized, controlled trial among 2163 adult smokers at eight primary care clinics--four test sites and four control sites--in southern Wisconsin. At the test sites, intake clinicians were instructed in how to assess a patient's smoking status and offer assistance to those patients who wished to quit smoking. These patients were offered, free of charge, nicotine patches and/or proactive telephone counseling to assist them in quitting. Staff at the control sites received only general information about the AHRQ Guideline. Patients' self-reported abstinence from smoking was assessed by telephone interviews 2 and 6 months after the initial visit.
Clinicians at test sites followed the Guideline more often than those at the control sites. Test site patients were more likely than control site patients to be asked about their smoking status and their willingness to quit, to be given literature about quitting, to set a date to quit smoking, and to discuss pharmacotherapy--treatment with drugs--such as nicotine replacement. Increased adherence to the Guideline also led to improved rates of smoking cessation. Test site patients were more likely than control site patients to report abstinence from smoking at the 2-month follow-up interview (16% versus 6% respectively), 6-month follow-up interview (15% versus 10%) and continuous abstinence, defined as abstinence at both the 2- and 6-month follow-ups (11% versus 4%).
"For the 70% of U.S. smokers who visit their physicians at least once a year, exposure to this opportunistic intervention could potentially lead to smoking cessation for approximately 2 million patients annually," the authors write. "To realize these benefits, health care organizations should aim to enhance the impact of brief counseling in primary care settings by providing effective drug and behavioral therapies for properly selected smokers who are committed to quitting."
In an editorial, Robert A. Schnoll, Ph.D., and Paul F. Engstrom, M.D., of the Fox Chase Cancer Center in Philadelphia, discuss the need to improve the proportion of patients who receive physician-based treatment for smoking cessation. "[This] study demonstrates that, not only is it feasible to increase adherence to the Guideline among physician-based medical practices but also that such efforts are cost-effective, improve clinical practices by enhancing clinician self-efficacy and role satisfaction and, importantly, reduce patient tobacco use," Schnoll and Engstrom write.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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