title: Smoking cessation in primary care clinics.
abstract: OBJECTIVE
  To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Two university-affiliated community primary care clinics.
  
  
  METHODS
  Two hundred five smokers with routinely scheduled appointments.
  
  
  METHODS
  All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements.
  
  
  RESULTS
  Quit rate was evaluated at 9-month follow-up. Eleven percent of smokers were sustained quitters at follow-up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy ( p =.05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%.
  
  
  CONCLUSIONS
  The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland, OR97201, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Sippel
authors.forename: M L
authors.initials: ML
authors.lastname: Osborne
authors.forename: W
authors.initials: W
authors.lastname: Bjornson
authors.forename: B
authors.initials: B
authors.lastname: Goldberg
authors.forename: A S
authors.initials: AS
authors.lastname: Buist
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009042:Motivation; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D013997:Time Factors; D014481:United States; D016270:United States Agency for Healthcare Research and Quality