Background. The effectiveness of smoking cessation interventions may be influenced by a variety of patient characteristics, including level of nicotine addiction and readiness to change. We conducted this study to examine the relationship between these characteristics and the frequency of physician-initiated smoking cessation interventions. Methods. We identified smokers seen during office visits to 1 of 38 primary care physicians in rural Kansas. Trained students observed the frequency and nature of doctor-patient discussions related to tobacco. Telephone surveys were conducted with these patients 1 to 3 days after the office visit. Results. We completed observations and telephone surveys on 259 smokers. Tobacco-related discussions occurred during 66% of doctor-patient encounters. Although discussions overall were unrelated to a patient's readiness to quit, specific assistance with smoking cessation was offered less often to precontemplators (15%) than to contemplators (31%) or those preparing to quit (37%) (P < 0.05). While bupropion was discussed with 23% of smokers, nicotine replacement therapy was discussed with 12% and was unrelated to markers of nicotine addiction. Conclusions. Current efforts to promote smoking cessation are only marginally related to patient characteristics. Doctors are missing many opportunities to effectively intervene with patients who are contemplating smoking cessation or preparing to quit.
Bibliographical noteFunding Information:
Partial funding for this project was provided through the following grants: The Robert Wood Johnson Foundation Generalist Physicians Faculty Scholars Award (No. 032686) (J. S. Ahluwalia); Kansas Academy of Family Physicians (A. Greiner); J. H. Baker Trust of La Crosse, Kansas (A. Greiner); Kansas Association for Medically Underserved (A. Greiner); Primary Care Physician Education Grant from the Kansas Health Foundation. We thank the family physicians who not only provided a valuable learning experience for the students, but also allowed the data collection necessary for this paper. We appreciate the commitment of the students who collected the data. We thank Niaman Nazir, M.B.B.S., M.P.H., for his assistance throughout the course of this study.
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