Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs.
BACKGROUND
The U.S. Public Health Service clinical practice guideline calls for clinicians and healthcare organizations to identify and treat every tobacco user seen in a healthcare setting. There is little information on the extent of compliance with the guideline's treatment model described by the "5A's" (Ask, Advise, Assess, Assist, Arrange).


METHODS
In 1999-2000 a survey was mailed to 64,764 members aged 25 to 75 years, of nine nonprofit HMOs participating in the National Cancer Institute-funded Cancer Research Network. These plans provide medical care to more than 8 million Americans including a minority enrollment of 30%. Smokers were asked about tobacco-cessation treatments received during primary care visits in the past year.


RESULTS
A 70% response rate identified a smoking prevalence of 10% (n=4207). Results indicated that 90% of smokers were asked about smoking, 71% were advised to quit, 56% were assessed for their willingness to quit, 49% received assistance interventions, and 9% had follow-up arranged. Treatment was provided more often to smokers who asked for help and/or intended to quit. Few and only modest associations were found between other patient characteristics and receipt of 5A's cessation services. In contrast to widely reported concerns about smokers' resistance to tobacco interventions, smokers who received treatment were more satisfied with health plan services.


CONCLUSIONS
Results demonstrate substantial clinician compliance with the first two steps-Ask and Advise. Greater efforts are needed in providing the more effective tobacco treatments-Assist and Arrange. Compliance with the guideline is associated with greater patient satisfaction.
Quinn
Virginia P
VP
Kaiser Permanente Southern California, Research & Evaluation Department, Pasadena, California 91188, USA. virginia.p.quinn@kp.org
Stevens
Victor J
VJ
Hollis
Jack F
JF
Rigotti
Nancy A
NA
Solberg
Leif I
LI
Gordon
Nancy
N
Ritzwoller
Debra
D
Smith
K Sabina
KS
Hu
Weiming
W
Zapka
Jane
J
D000328:Adult; D000368:Aged; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009939:Organizations, Nonprofit; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016540:Smoking Cessation / Q000379:methods*; D014026:Nicotiana