Smoking cessation interventions in rural family practices: an UPRNet study.
BACKGROUND
Primary care physicians are urged to offer smoking cessation counseling to their patients. Many studies have sought to determine which smoking interventions are most effective in medical office settings. As a result, routine identification of smokers, brief counseling, referral to smoking cessation programs, and nicotine replacement therapy are advocated. The context of patient visits during which smoking cessation advice is given, however, has received little attention. The objective of this study was to determine if patients' reasons for visits and self-reported readiness to quit smoking are associated with likelihood and type of smoking cessation intervention offered by family physicians.


METHODS
The study was conducted in the Upper Peninsula Research Network (UPRNet), a voluntary association of family physicians in 15 medical clinics located in rural areas of northern Michigan. Practice coordinators administered a 1-page exit questionnaire to every other adult patient seen by a participating physician immediately after the office visit. Clinicians were blinded to the specific purpose of the questionnaire. During the study, 2317 questionnaires were administered, yielding information on 455 smokers.


RESULTS
The overall rate of physicians' providing any smoking cessation intervention at any type of visit was 47%. There was a significant association between frequency of smoking cessation intervention and reasons for visits (chi 2 = 10.46, P = .01). There was a statistically significant difference between stages of readiness to quit and frequency of smoking cessation intervention offered (chi 2 = 26.5, P < .001). Clinicians offered smoking cessation interventions to smokers in the precontemplative stage significantly less often than to smokers in the contemplation, preparation, or action stages.


CONCLUSIONS
UPRNet practitioners vary the frequency of smoking cessation interventions according to patients' reasons for the medical visit and their readiness to quit smoking.
Sesney
J W
JW
Upper Peninsula Campus of the College of Human Medicine, Michigan State University, Escanaba, USA. John_Sesney@UPRNet.tfnet.org
Kreher
N E
NE
Hickner
J M
JM
Webb
S
S
D000208:Acute Disease; D000328:Adult; D001294:Attitude to Health; D003376:Counseling; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use; D009819:Office Visits; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011315:Preventive Medicine; D012017:Referral and Consultation; D012423:Rural Health; D016037:Single-Blind Method; D012907:Smoking / Q000523:psychology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries
D009538:Nicotine