title: Treatment of tobacco use as a chronic medical condition: primary care physicians' self-reported practice patterns.
abstract: BACKGROUND
  The goal of this study is to better understand factors related to physician treatment of tobacco as a chronic medical condition.
  
  
  METHODS
  In the fall of 2000, we conducted a mail survey of primary care physicians in a large mid-western health plan. The response rate was 61% (750/1235). The survey assessed physician attitude, perceived clinic support, training, and self-reported tobacco treatment practices.
  
  
  RESULTS
  Twenty-nine percent of physicians reported incomplete or minimal care. Thirty-nine percent reported providing assistance without follow-up, while 21% reported providing follow-up to tobacco users making quit attempts. Only 12% of physicians reported assistance and follow-up for all tobacco users. Controlling for differences in physician and clinic characteristics, more positive physician attitudes decreased incomplete or minimal care (OR = 4.62 most positive tertile vs. least positive, P < 0.001) but did not increase follow-up activities. Higher perceived clinic support increased follow-up care (OR = 2.69, highest tertile vs. lowest, P < 0.001). Physician training was associated with increased provision of ongoing care (OR = 1.88 per additional hour of training, P < 0.001).
  
  
  CONCLUSIONS
  Physician attitudes, clinic support, and training are related to different steps in the adoption of more complete tobacco use treatment. These findings support the need for multifaceted approaches to improve tobacco treatment as a chronic medical condition.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Minnesota, Minneapolis, MN 55455-0341, USA. lcan@umn.edu
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: An
authors.forename: Terence S
authors.initials: TS
authors.lastname: Bernhardt
authors.forename: James
authors.initials: J
authors.lastname: Bluhm
authors.forename: Patricia
authors.initials: P
authors.lastname: Bland
authors.forename: Bruce
authors.initials: B
authors.lastname: Center
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
authors.forename: Steven S
authors.initials: SS
authors.lastname: Foldes
authors.forename: Sanne
authors.initials: S
authors.lastname: Magnan
authors.forename: Marc
authors.initials: M
authors.lastname: Manley
mesh_terms: D002908:Chronic Disease; D006801:Humans; D008910:Minnesota; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration*; D014029:Tobacco Use Disorder / Q000628:therapy*