Documentation of the 5 as for smoking cessation by PCPs across distinct health systems.
OBJECTIVE
Physicians can help patients quit smoking using the 5 As of smoking cessation. This study aimed to (1) identify the proportion of known smokers that receive smoking cessation services in the course of routine clinical practice; (2) describe demographic and comorbidity characteristics of patients receiving the 5 As in these systems; and (3) evaluate differences in performance of the 5 As across health systems, gender, and age categories.


METHODS
Electronic medical records of 200 current smokers from 6 unique health systems (N = 1200) were randomly selected from 2006 to 2010. Primary care encounter progress notes were hand coded for occurrences of the 5 As.


METHODS
Bivariate comparisons of delivery of the 3 smoking-cessation services by site, gender, and age category were analyzed using χ² tests.


RESULTS
About 50% of smokers were advised to quit smoking, 39% were assessed for their readiness to quit, and 54% received some type of assistance to help them quit smoking. Only 2% had a documented plan for follow-up regarding their quitting efforts (arrange). Significant differences were found among sites for documentation of receiving the 5 As and between age groups receiving assistance with quitting. There was no statistically significant difference between genders in receipt of the 5 As.


CONCLUSIONS
Documentation of adherence to the 5 As varied by site and some demographics. Adjustments to protocols for addressing cessation and readiness to quit may be warranted. Health systems could apply the methodology described in this paper to assess their own performance, and then use that as a basis to guide improvement initiatives.
Rebecca J
RJ
Williams
Andrew L
AL
Masica
Mary Ann
MA
McBurnie
Leif I
LI
Solberg
Steffani R
SR
Bailey
Brian
B
Hazlehurst
Stephen E
SE
Kurtz
Andrew E
AE
Williams
Jon E
JE
Puro
Kaiser Permanente Center for Health Research Northwest, 3800 N Interstate Ave, Portland, OR 97227. E-mail: Victor.J.Stevens@kpchr.org.
Victor J
VJ
Stevens
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D037001:Directive Counseling; D004282:Documentation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D044469:Racial Groups; D016540:Smoking Cessation; D061485:Tobacco Use Cessation Devices; D014481:United States / Q000453:epidemiology; D055815:Young Adult