Direct observation of smoking cessation activities in primary care practice.
OBJECTIVE
Our goals were to determine how often family physicians incorporate smoking cessation efforts into routine office visits and to examine the effect of patient, physician, and office characteristics on the frequency of these efforts.


METHODS
Data was gathered using direct observation of physician-patient encounters, a survey of physicians, and an on-site examination of office systems for supporting smoking cessation.


METHODS
We included patients seen for routine office visits in 38 primary care physician practices.


METHODS
The frequency of tobacco discussions among all patients, the extent of these discussions among smokers, and the presence of tobacco-related systems and policies in physicians' offices were measured.


RESULTS
Tobacco was discussed during 633 of 2963 encounters (21%; range among practices = 0%-90%). Discussion of tobacco was more common in the 58% of practices that had standard forms for recording smoking status (26% vs 16%; P=.01). Tobacco discussions were more common during new patient visits but occurred less often with older patients and among physicians in practice more than 10 years. Of 244 smokers identified, physicians provided assistance with smoking cessation for 38% (range among practices = 0%-100%). Bupropion and nicotine-replacement therapy were discussed with smokers in 31% and 17% of encounters, respectively. Although 68% of offices had smoking cessation materials for patients, few recorded tobacco use in the "vital signs" section of the patient history or assigned smoking-related tasks to nonphysician personnel.


CONCLUSIONS
Smoking cessation practices vary widely in primary care offices. Strategies are needed to assist physicians with incorporating systematic approaches to maximize smoking cessation rates.
Ellerbeck
E F
EF
Department of Preventive Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160-7313, USA. eellerbe@kumc.edu.
Ahluwalia
J S
JS
Jolicoeur
D G
DG
Gladden
J
J
Mosier
M C
MC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D007615:Kansas; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009819:Office Visits; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000193:education / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012737:Sex Factors; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*