Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions

Goldstein, Michael G.; Niaura, Raymond; Willey, Cynthia; DePue, Judith D.; Eaton, Cheryl A.; Rakowski, William; Dubé, Catherine

doi:10.1001/archinte.157.12.1313

Cited by 93 publications

(64 citation statements)

References 17 publications

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“…The estimated standard Tobacco Use: (circle one) Current Former Never deviation for between-practice variation in A 2 was 10% to 12% and 12% to 14%, respectively, for intervention practices and control practices. We reasoned that because A 2 is the most frequently delivered subcomponent of counseling, 11,13,[26][27][28] its standard deviation would reasonably approximate variation rates for counseling in general. For control practices, we assumed a counseling rate of 50% and a between-practice standard deviation of 14%.…”

Section: Power Analysismentioning

confidence: 99%

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Rothemich¹,

Woolf²,

Johnson³

et al. 2008

The Annals of Family Medicine

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PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention infl uences patient-reported frequency and intensity of tobacco cessation counseling. METHODSThis study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identifi cation system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion.RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P = .04). There was no signifi cant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P = .18). CONCLUSIONSThe vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.

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Section: Power Analysismentioning

confidence: 99%

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Rothemich¹,

Woolf²,

Johnson³

et al. 2008

The Annals of Family Medicine

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“…Self-efficacy to counsel smokers is associated with increased tobacco counseling among physicians (Cabana et al, 2004;Frank, Winkleby, Altman, Rockhill, & Fortmann, 1991;Goldstein et al, 1997;Zapka et al, 1999) and nurses (Borrelli et al, 2001). One cross-sectional study of HHC nurses found that, for every one-point increase in self-efficacy, there was a 30% increase in the odds that nurses would counsel their patients who smoked (Borrelli et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses

Borrelli

Lee

Novak

2008

Preventive Medicine

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Objective-We prospectively examined whether training home health care nurses is associated with changes in attitudes towards smoking cessation counseling and counseling behaviors.Methods-We trained 98 home health care nurses to deliver cessation counseling to their patients. Measures were administered at pre-training, post-training, and six months later. This was part of a larger study conducted in Providence, RI, USA (1998-2002.Results-Compared with pre-training, at post-training, nurses reported significantly higher levels of self-efficacy to counsel, positive outcome expectations, optimism that patients would follow their advice, perceived worth of smoking counseling, perceived importance of quitting smoking, and perceived organizational support. These training effects were maintained six-months later. Between the end of training and the six-month follow-up, nurses reported significant increases in their perceived effectiveness to counsel smokers and confidence to encourage behavior change. Compared with pre-training, at six month follow-up, nurses were significantly more likely to ask about smoking status, assess readiness to quit, advise to quit, assist with quitting, and arrange follow-up. Nurses spent significantly more time counseling smokers at 6 months than at pre-training, and were less likely to selectively counsel.Conclusions-Brief training facilitates both short-and long-term changes in nurse attitudes and behaviors regarding smoking cessation counseling.

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“…For example, in a study of national patterns of treatment, smoking status was identified in approximately 67% of clinic visits, but smoking cessation assistance was offered to only 21% of those smokers (Thorndike, Rigotti, Stafford, & Singer, 1998). Another population-based survey found that fewer than 15% of smokers who visited a physician were offered smoking cessation assistance, and only 3% were scheduled for follow-up appointments to monitor their tobacco use (Goldstein et al, 1997). This lack of assistance in quitting cigarette smoking is particularly problematic for women, as research indicates that physicians are less likely to ascertain women's smoking status and to advise women to quit smoking (Rogers, Johnson, Young, & Graney, 1997;Young & Ward, 1998), and women seem to have more difficulties in quitting cigarette smoking than men (Fiore et al, 2000).…”

mentioning

confidence: 99%

Meta-Analysis of the Efficacy of Nicotine Replacement Therapy for Smoking Cessation: Differences Between Men and Women.

Cepeda-Benito¹,

Reynoso²,

Erath³

2004

Journal of Consulting and Clinical Psychology

256

151

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Gender differences in the efficacy of nicotine replacement therapies (NRTs) were examined in a meta-analytical review of 90 effect sizes obtained from a sample of 21 double-blind, placebo-controlled randomized studies. Although NRT was more effective for men than placebo at 3-month, 6-month, and 12-month follow-ups, the benefits of NRT for women were clearly evident only at the 3-and 6-month follow-ups. Giving NRT in conjunction with high-intensity nonpharmacological support was more important for women than men. That is, NRT and low support were efficacious for women at only short-term follow-up, and men benefited from NRT at all the follow-ups regardless of the intensity of the adjunct support. The results suggest that long-term maintenance of NRT treatment gains decrease more rapidly for women than men.

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Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions

Cited by 93 publications

References 17 publications

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses

Meta-Analysis of the Efficacy of Nicotine Replacement Therapy for Smoking Cessation: Differences Between Men and Women.

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