title: Smoking cessation in primary care: a clinical effectiveness trial of two simple interventions.
abstract: BACKGROUND
  Many primary care practices do not have systematic protocols to identify patients who smoke or to encourage clinicians to provide smoking cessation advice. We designed a study to assess the relative effectiveness of two brief interventions on screening for smoking, physician cessation advice and patient smoking cessation rates.
  
  
  METHODS
  We performed a nonrandomized comparison of alternative strategies for smoking cessation at a hospital-based adult primary care practice. Each intervention was implemented on a separate practice team. The "minimal" intervention consisted of a smoking status "vital sign" stamp which documented patient smoking status. The "enhanced" intervention consisted of a five-question form that assessed patient level of cessation readiness and provided cessation-counseling prompts for clinicians. Medical record documentation of screening for smoking and cessation advice and self-reported patient smoking cessation rates were collected 8-10 months after implementation.
  
  
  RESULTS
  Smoking status was documented at 86%, 91%, and 49%, and cessation advice at 38%, 47%, and 30% of visits on the minimal, enhanced, and control teams, respectively (P < 0.001 for smoking status and P = 0.014 for advice). Self-reported patient smoking cessation was higher on the enhanced team (12%) compared with the minimal (2%) and control (4%) teams (P < 0.001).
  
  
  CONCLUSIONS
  A short questionnaire that assesses readiness-to-quit and provides documentation of cessation advice improves rates of clinician cessation advice and patient smoking cessation compared with no intervention.
authors.affiliation: Division of Clinical Care Research, Tufts New England Medical Center, Boston, MA 02111, USA. cmilch@tufts-nemc.org
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Milch
authors.forename: Janet M
authors.initials: JM
authors.lastname: Edmunson
authors.forename: Joni R
authors.initials: JR
authors.lastname: Beshansky
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Harry P
authors.initials: HP
authors.lastname: Selker
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome