The Treatment of Smoking by US Physicians During Ambulatory Visits: 1994 2003

Overview

Journal Am J Public Health

Specialty Public Health

Date 2007 Sep 1

PMID 17761570

Citations 62

Authors

Anne N Thorndike

Susan Regan

Nancy A Rigotti

Affiliations

Soon will be listed here.

Abstract

Objectives: We sought to determine whether US physicians' practice patterns in treating tobacco use at ambulatory visits improved over the past decade with the appearance of national clinical practice guidelines, new smoking cessation medications, and public reporting of physician performance in counseling smokers.

Methods: We compared data from the National Ambulatory Medical Care Survey, an annual survey of a random sample of office visits to US physicians, between 1994-1996 and 2001-2003.

Results: Physicians identified patients' smoking status at 68% of visits in 2001-2003 versus 65% in 1994-1996 (adjusted odds ratio [AOR]=1.16; 95% confidence interval [CI]=1.04, 1.30). Physicians counseled about smoking at 20% of smokers' visits in 2001-2003 versus 22% in 1994-1996 (AOR=0.84; 95% CI=0.71, 0.99). In both time periods, smoking cessation medication use was low (<2% of smokers' visits) and visits with counseling for smoking were longer than those without such counseling (P<.005).

Conclusions: In the past decade, there has been a small increase in physicians' rates of patients' smoking status identification and a small decrease in rates of counseling smokers. This lack of progress may reflect barriers in the US health care environment, including limited physician time to provide counseling.

Citing Articles

Investigating disparities in smoking cessation treatment for veterans with multiple sclerosis: A national analysis.

Polick C, Dennis P, Calhoun P, Braley T, Lee E, Wilson S Brain Behav. 2024; 14(5):e3513.

PMID: 38698620 PMC: 11066415. DOI: 10.1002/brb3.3513.

Leveraging Implementation Science in the Treatment of Tobacco Use Disorder.

Ramsey A, Cavazos-Rehg P, Chen L, Bierut L Mo Med. 2023; 120(4):285-291.

PMID: 37609466 PMC: 10441270.

Genomic medicine to reduce tobacco and related disorders: Translation to precision prevention and treatment.

Chen L, Baker T, Ramsey A, Amos C, Bierut L Addict Neurosci. 2023; 7.

PMID: 37602286 PMC: 10434839. DOI: 10.1016/j.addicn.2023.100083.

Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies.

Tildy B, McNeill A, Perman-Howe P, Brose L BMC Prim Care. 2023; 24(1):32.

PMID: 36698052 PMC: 9875430. DOI: 10.1186/s12875-023-01981-2.

A Proactive Outreach Strategy Using a Local Area Code to Refer Unassisted Smokers in a Safety Net Health System to a Quitline: A Pragmatic Randomized Trial.

Valencia C, Dove M, Cummins S, Kirby C, Zhu S, Giboney P Nicotine Tob Res. 2022; 25(1):43-49.

PMID: 36103393 PMC: 9717369. DOI: 10.1093/ntr/ntac156.

References

Cabana M, Rand C, Powe N, Wu A, Wilson M, Abboud P . Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282(15):1458-65. DOI: 10.1001/jama.282.15.1458. View

Stevens V, Solberg L, Quinn V, Rigotti N, Hollis J, Smith K . Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs. J Natl Cancer Inst Monogr. 2005; (35):75-80. DOI: 10.1093/jncimonographs/lgi042. View

Burton S, Gitchell J, Shiffman S . Use of FDA-approved pharmacologic treatments for tobacco dependence--United States, 1984-1998. MMWR Morb Mortal Wkly Rep. 2000; 49(29):665-8. View

Ellerbeck E, Ahluwalia J, Jolicoeur D, Gladden J, Mosier M . Direct observation of smoking cessation activities in primary care practice. J Fam Pract. 2001; 50(8):688-93. View

Jaen C, McIlvain H, Pol L, Phillips Jr R, Flocke S, Crabtree B . Tailoring tobacco counseling to the competing demands in the clinical encounter. J Fam Pract. 2001; 50(10):859-63. View

Stange K, Woolf S, Gjeltema K . One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med. 2002; 22(4):320-3. DOI: 10.1016/s0749-3797(02)00413-0. View

. Annual smoking-attributable mortality, years of potential life lost, and economic costs--United States, 1995-1999. MMWR Morb Mortal Wkly Rep. 2002; 51(14):300-3. View

Denny C, Serdula M, Holtzman D, Nelson D . Physician advice about smoking and drinking: are U.S. adults being informed?. Am J Prev Med. 2003; 24(1):71-4. DOI: 10.1016/s0749-3797(02)00568-8. View

Yarnall K, Pollak K, Ostbye T, Krause K, Michener J . Primary care: is there enough time for prevention?. Am J Public Health. 2003; 93(4):635-41. PMC: 1447803. DOI: 10.2105/ajph.93.4.635. View

10.

Cherry D, Burt C, Woodwell D . National Ambulatory Medical Care Survey: 2001 summary. Adv Data. 2003; (337):1-44. View

11.

Schroeder S . Tobacco control in the wake of the 1998 master settlement agreement. N Engl J Med. 2004; 350(3):293-301. DOI: 10.1056/NEJMsr031421. View

12.

Fiore M, Croyle R, Curry S, Cutler C, Davis R, Gordon C . Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. Am J Public Health. 2004; 94(2):205-10. PMC: 1448229. DOI: 10.2105/ajph.94.2.205. View

13.

Mokdad A, Marks J, Stroup D, Gerberding J . Actual causes of death in the United States, 2000. JAMA. 2004; 291(10):1238-45. DOI: 10.1001/jama.291.10.1238. View

14.

Boyle R, Solberg L . Is making smoking status a vital sign sufficient to increase cessation support actions in clinical practice?. Ann Fam Med. 2004; 2(1):22-5. PMC: 1466625. DOI: 10.1370/afm.38. View

15.

Hing E, Gousen S, Shimizu I, Burt C . Guide to using masked design variables to estimate standard errors in public use files of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Inquiry. 2004; 40(4):401-15. DOI: 10.5034/inquiryjrnl_40.4.401. View

16.

Bryant E, Shimizu I . Sample design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. Vital Health Stat 2. 1988; (108):1-39. View

17.

Lewis C, Clancy C, Leake B, Schwartz J . The counseling practices of internists. Ann Intern Med. 1991; 114(1):54-8. DOI: 10.7326/0003-4819-114-1-54. View

18.

Thompson R, Taplin S, McAfee T, Mandelson M, Smith A . Primary and secondary prevention services in clinical practice. Twenty years' experience in development, implementation, and evaluation. JAMA. 1995; 273(14):1130-5. View

19.

Wechsler H, Levine S, Idelson R, Schor E, Coakley E . The physician's role in health promotion revisited--a survey of primary care practitioners. N Engl J Med. 1996; 334(15):996-8. DOI: 10.1056/NEJM199604113341519. View

20.

Ward J, Sanson-Fisher R . Accuracy of patient recall of opportunistic smoking cessation advice in general practice. Tob Control. 1996; 5(2):110-3. PMC: 1759509. DOI: 10.1136/tc.5.2.110. View