Training Physicians to Do Office-based Smoking Cessation Increases Adherence to PHS Guidelines
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Cigarette Smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the “2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence” and the “Pathways to Freedom” tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five “A’s” recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five “A’s” score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first “A” (“asked”) both pre- and post-intervention, and the other four “A’s” all had statistically significant increases pre-to post-intervention. Conclusions: The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.
- Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238–1245. CrossRef
- Centers for Disease Control and Prevention. (2010). Behavioral Risk Factor Surveillance System 2009 survey. http://apps.nccd.cdc.gov. Accessed June 4, 2010.
- Pignone, M., & Salazar, R. (2009). Disease prevention and health promotion. In McPhee, S. J. & Papdakis, M. A. (Eds). Current medical diagnosis and treatment (p. 6). New York: Lange Medical Book/McGraw Hill.
- Ahluwalia, J. S., Harris, K. J., Catley, D., Okuyemi, K. S., & Mayo, M. S. (2002). Sustained release bupropion for smoking cessation in African Americans: a randomized control trial. Journal of American Medical Association, 288, 468–474. CrossRef
- DePue, J. D., Goldstein, M. G., Schilling, A., Reiss, P., Papandonatos, G., Sciamanna, C., et al. (2002). Dissemination of the AHCRP clinical practice guideline in community health centres. Tobacco Control, 11, 329–335. CrossRef
- Katz, D. A., Muehlenbruch, D. R., Brown, R. B., Fiore, M. C., Baker, T. B. (2002). Effectiveness of a clinic-based strategy for implementing the AHRQ smoking cessation guideline in primary care. Preventive Medicine 35, 293–302.
- Goldstein, M. G., Niaura, R., Willey, C., Kazura, A., Rakowski, W., DePue, J., et al. (2003). An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: Smoking cessation outcomes of the physicians counseling smokers’ project. Preventive Medicine, 36, 185–196. CrossRef
- Thorndike, A. N., Regan, S., & Rigotti, N. A. (2007). The treatment of smoking by US physicians during ambulatory visits: 1994 2003. American Journal of Public Health, 97, 1878–1883. CrossRef
- Tong, E. K., Strouse, R., Hall, J. D., Kovac, M., & Schroeder, S. A. (2010). National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs. Nicotine & Tobacco Research Advance Access published online on May 27, 2010.
- Report of the Surgeon General on Tobacco Use among US Racial/Ethnic Minority Groups. (1998). Washington DC: US Department of Health and Human Services.
- Schauffler, H. H., Mordavsky, J. K., & McMenamin, S. (2001). Adoption of the AHCPR clinical practice guideline for smoking cessation: A survey of California’s HMOs. American Journal of Preventive Medicine, 21, 153–161. CrossRef
- Burns, M. E., & Fiore, M. C. (2001). Under-use of tobacco dependence treatment among Wisconsin’s fee-for-service Medicaid recipients. Wisconsin Medical Journal, 100, 54–58.
- Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. C., et al. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA, 282(15), 1458–1465. CrossRef
- Tunis, S. R., Hayward, R. S., Wilson, M. C., Rubin, H. R., Bass, E. B., Johnston, M., et al. (1994). Internists’ attitudes about clinical practice guidelines. Annals of Internal Medicine, 120, 965–966.
- Jean, C. R., McIlvain, H., Pol, L., Phillips, R. L., Flock, S., & Crabtree, B. F. (2001). Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice, 50, 859–863.
- Berman, B. A., Yancey, A. K., Bastani, R., Grosser, S. C., Staveren, A., Williams, R. A., et al. (1997). African-American physicians and smoking cessation counseling. Journal of the National Medical Association, 89, 534–542.
- Hill, H. A., & Braithwaite, R. L. (1997). Attitudes, beliefs, and practices regarding smoking and smoking cessation among African American physicians and dentists. Journal of the National Medical Association, 89, 745–751.
- Fiore, M., Bailey, W., Cohen, S., Dorfman, S., Goldstein, M., Gritz, E., et al (2000). Treating tobacco use and dependence. Clinical Practice Guideline. Rockville (MD): U.S. Department of Health and Human Services, U.S. Public Health Service; 2000. Available at: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf.
- http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/pathways/pdfs/pathways.pdf. Accessed June 4, 2010.
- Blumenthal, D. S. (2007). Barriers to the provision of smoking cessation services reported by clinicians serving underserved communities. Journal of the American Board of Family Medicine, 20, 272–279. CrossRef
- Jaen, C. R., Stange, K. C., Tumiel, L. M., & Nutting, P. (1997). Missed opportunities for prevention: Smoking cessation counseling and the competing demands of practice. Journal of Family Practice, 45, 348–354.
- Wadland, W. C., Stoffelmayr, B., Berger, E., Crombach, A., & Ives, K. (1999). Enhancing smoking cessation rates in primary care. Journal of Family Practice, 48, 711–718.
- Katz, D. A., Muehlenbruch, D. R., Brown, R. B., Fiore, M. C., Baker, T. B., & The AHRQ Smoking Cessation Guideline Study Group. (2002). Effectiveness of a clinic-based strategy for implementing the AHRQ smoking cessation guideline in primary care. Preventive Medicine, 35, 293–301. CrossRef
- Katz, D. A., Muehlenbruch, D. R., Brown, R. B., Fiore, M. C., Baker, T. B., The AHRQ Smoking Cessation Guideline Study Group. (2004). Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: A randomized, controlled trial. Journal of the National Cancer Institute 96(8), 594–603. doi:10.1093/jnci/djh103.
- Spangler, J. G., George, G., & Foley, K. L. (2002). Crandall SJ: Tobacco intervention training: current efforts and gaps in US medical schools. JAMA, 288, 1102–1109. CrossRef
- Training Physicians to Do Office-based Smoking Cessation Increases Adherence to PHS Guidelines
Journal of Community Health
Volume 36, Issue 2 , pp 238-243
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Five “A’s”
- Smoking cessation
- Training physicians
- Author Affiliations
- 1. Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA, 30310-1495, USA
- 2. Oklahoma State Department of Health, Oklahoma City, OK, USA
- 3. Morehouse School of Medicine, Atlanta, GA, USA