Training physicians to do office-based smoking cessation increases adherence to PHS guidelines

Abstract

Cigarette smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the "2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence" and the "Pathways to Freedom" tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five "A's" recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five "A's" score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first "A" ("asked") both pre- and post-intervention, and the other four "A's" all had statistically significant increases pre-to post-intervention.

Conclusions: The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.