Adoption of policies to treat tobacco dependence in U.S. medical groups.
BACKGROUND
There remains an ongoing need to reduce tobacco use in the U.S. Physician organizations, such as medical groups, can support healthcare providers to be more effective in their delivery of tobacco cessation by adopting practices recommended in the Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (PHS Guideline).


OBJECTIVE
To document the extent to which activities to reduce tobacco use, as recommended in the PHS Guideline as system-level interventions, are provided within large medical groups in the U.S.


METHODS
During 2006-2007, data were collected on 339 medical groups operating in the U.S., with 20 or more physicians treating at least one of four chronic conditions. Organizations were surveyed regarding activities to reduce tobacco use as recommended in the PHS Guideline as system-level interventions (i.e., tobacco-use status documentation, policies to promote provider interventions, and staff dedicated to treating tobacco dependence). Between 2008 and 2009, bivariate associations and multivariate logistic regression models assessed the relationship of organizational characteristics and external incentives with adoption of systems strategies for treating tobacco dependence.


RESULTS
Nearly 83% of medical groups with 20 or more physicians operating in the U.S. in 2006-2007 have adopted one or more strategies recommended as effective to support the treatment of tobacco dependence. However, only 5.6% of medical groups engage in all eight tobacco control activities examined in this study. The two factors that were associated most consistently with medical group policies to treat tobacco dependence were the patient-centeredness of the organization and participation in a quality demonstration program.


CONCLUSIONS
There is much room for improvement in increasing medical group adoption of systems strategies to reduce tobacco use. The findings in this paper suggest recommendations to achieve these improvements.
Center for Health and Public Policy Studies, University of California, Berkeley, 94720-7360, USA. saram@berkeley.edu
Sara B
SB
McMenamin
Nicole M
NM
Bellows
Helen A
HA
Halpin
Diane R
DR
Rittenhouse
Lawrence P
LP
Casalino
Stephen M
SM
Shortell
D006123:Group Practice / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D016015:Logistic Models; D018802:Patient-Centered Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020340:Tobacco Use Cessation; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States