Original Articles

Journal of General Internal Medicine

, Volume 9, Issue 7, pp 379-384

First online:

The physician-delivered smoking intervention project

Factors that determineHow Much the physician intervenes with smokers
  • Judith K. OckeneAffiliated withthe Department of Medicine, Division of Preventive and Behavioral Medicine, the University of Massachusetts Medical School
  • , Abigail AdamsAffiliated withthe Department of Medicine, Division of General Medicine, the University of Massachusetts Medical School
  • , Lori PbertAffiliated withthe Department of Medicine, Division of Preventive and Behavioral Medicine, the University of Massachusetts Medical School
  • , Rose LuippoldAffiliated withthe Department of Medicine, Division of Preventive and Behavioral Medicine, the University of Massachusetts Medical School
  • , James R. HebertAffiliated withthe Department of Medicine, Division of Preventive and Behavioral Medicine, the University of Massachusetts Medical School
  • , Mark QuirkAffiliated withthe Department of Family and Community Medicine, the University of Massachusetts Medical School
  • , Kathryn KalanAffiliated withthe Department of Medicine, Division of Preventive and Behavioral Medicine, the University of Massachusetts Medical School

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Abstract

Objective: To determine factors that affect how much physicians trained to use a patient-centered smoking intervention intervene with their smoking patients.

Design: Forty internal medicine residents and ten internal medicine attending physicians trained in a patient-centered counseling approach were randomized to an algorithm condition (provision of intervention algorithm at each patient visit) or a no-algorithm condition. Smoking intervention steps used by physicians with patients were assessed with Patient Exit Interviews (PEIs).

Setting: Ambulatory clinic; academic medical center.

Patients: Five hundred twenty-seven adult smokers seen in clinic between June 1990 and April 1992.

Main results: There was no difference in overall PEI scores or in individual PEI steps taken between the algorithm and no-algorithm conditions. Two patient baseline factors (reporting thinking of stopping smoking within six months and higher Fagerstrom Tolerance Score) and one physician factor (older age) were significantly predictive of higher PEI score.

Conclusion: Provision of an intervention algorithm at each patient visit does not increase the likelihood that trained physicians who are cued to intervene will perform more of the intervention steps taught. Trained physicians are more likely to intervene with smokers who are more nicotine-dependent and who expect and desire to stop smoking.

Key words

psychosocial factors smoking cessation patient-centered counseling intervention algorithm