Treatment of tobacco use as a chronic medical condition: Primary care physicians' self-reported practice patterns

Background. The goal of this study is to better understand factors related to physician treatment of tobacco as a chronic medical condition. Methods. In the fall of 2000, we conducted a mail survey of primary care physicians in a large mid-western health plan. The response rate was 61% (750/1235). The survey assessed physician attitude, perceived clinic support, training, and self-reported tobacco treatment practices. Results. Twenty-nine percent of physicians reported incomplete or minimal care. Thirty-nine percent reported providing assistance without follow-up, while 21% reported providing follow-up to tobacco users making quit attempts. Only 12% of physicians reported assistance and follow-up for all tobacco users. Controlling for differences in physician and clinic characteristics, more positive physician attitudes decreased incomplete or minimal care (OR = 4.62 most positive tertile vs. least positive, P < 0.001) but did not increase follow-up activities. Higher perceived clinic support increased follow-up care (OR = 2.69, highest tertile vs. lowest, P < 0.001). Physician training was associated with increased provision of ongoing care (OR = 1.88 per additional hour of training, P < 0.001). Conclusions. Physician attitudes, clinic support, and training are related to different steps in the adoption of more complete tobacco use treatment. These findings support the need for multifaceted approaches to improve tobacco treatment as a chronic medical condition.