Assessment of the Efficiency of Tobacco Cessation Counseling in Primary Care.
Clinical Practice Guidelines for Treating Tobacco Use and Dependence advocate for using counseling targeted at tobacco users' motivation to quit during each office visit. We evaluate tobacco use screening and counseling interventions delivered during routine periodic health examinations by 44 adult primary care physicians practicing in 22 clinics of a large health system in southeast Michigan. 484 office visits were audio-recorded and transcribed. For this study, current tobacco users (N = 91) were identified using pre-visit surveys and audio-recordings. Transcripts were coded for the delivery of tobacco-related counseling interventions. The extent to which counseling interventions were used and/or targeted to the patients' readiness to quit was the main outcome measure. The majority of tobacco users (n = 77) had their tobacco use status assessed, and most received some sort of tobacco-related counseling (n = 74). However, only 15% received the recommended counseling targeted to their readiness to quit. On the other hand, 19% received less counseling than recommended given their readiness to quit, 7% received only nonindicated counseling, and 59% received nonindicated counseling in addition to indicated counseling. Results illustrate physicians' commitment to cessation counseling and also identify potential opportunities to improve the efficiency of tobacco-related counseling in primary care.
Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA elshahawyo@vcu.edu.
Omar
O
El-Shahawy
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
Deirdre A
DA
Shires
Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
Jennifer
J
Elston Lafata
D000368:Aged; D003376:Counseling / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D015397:Program Evaluation; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D020340:Tobacco Use Cessation / Q000379:methods / Q000706:statistics & numerical data
cessation counseling; cessation guidelines; efficiency; primary care; tobacco use