Tobacco Intervention Practices of Primary Care Physicians Treating Lower Socioeconomic Status Patients

Abstract

Tobacco use greatly contributes to overall socioeconomic health disparities and physicians are a major source of information about effective methods for tobacco cessation. This study examined the tobacco intervention practices of primary care physicians in Arkansas who treat a high proportion of lower SES patients. Greater than 70% of respondents’ patients were covered by Medicaid and/or Medicare or paid for primary care services without health insurance. Although physicians were highly motivated and considered cessation to be very important, 74% had no training of any kind in the treatment of tobacco dependence and familiarity with the free treatment services in Arkansas was low. Younger and non-white physicians and physicians with any type of training in treating tobacco dependence reported more positive attitudes, more frequent intervention behaviors, and more familiarity with treatment services. More frequently seeing the effects of tobacco use on the health of patients as well as increased knowledge, preparedness, and perceived effectiveness of treatments was related to a higher frequency of providing cessation assistance. More frequently seeing the effects of tobacco use on patients, as well as increased familiarity with treatment services was related to a higher frequency of referring patients to treatment services. These findings suggest that training experiences that increase physician awareness of the multiplicity of consequences of tobacco use as well as increase knowledge, preparedness, perceived effectiveness of treatments, and familiarity with treatment services will increase the frequency with which physicians assist and refer this important patient population.

Socioeconomic Disparities in Community-Based Treatment of Tobacco Dependence

“…These results were consistent with the notion that providers who are familiar with treatment programs and have training are more likely to refer. 72,73 Higher-SES smokers were referred more frequently by television or radio advertisements for the quitline, supporting previous contentions that quitline television and radio advertisements enhance socioeconomic disparities. 74,75 …”

The impact of brief tobacco treatment training on practice behaviours, self-efficacy and attitudes among healthcare providers

“…Training has been shown to increase the frequency, quality and effectiveness with which providers deliver tobacco treatment, confidence to perform those clinical activities, and related attitudes regarding the value of tobacco treatment (7,(10)(11)(12)(13). In addition, more intensive training has been shown to yield improved outcomes (14)(15)(16)(17).…”

Increasing the Quality and Availability of Evidence-based Treatment for Tobacco Dependence through Unified Certification of Tobacco Treatment Specialists

“…Sufficient availability of highly proficient practitioners is necessary to train practitioners who deliver brief, low-intensity interventions. At present, the vast majority of health care practitioners have not received even the minimal training needed to effectively deliver a brief, low-intensity evidence-based treatment (Applegate et al, 2008;Sheffer et al, 2012;Steinberg et al, 2006). Sufficient availability of highly proficient TTSs is also necessary to support the efforts of health care providers who identify tobacco users in need of higher intensity treatment, to support innovative chronic care models such as the Ask-Advise-Connect (Vidrine et al, 2013), and to treat tobacco users with complex presentations who do not respond to lower intensity treatment.…”

“…Given the opportunities provided by a significant reach into the smoking population, the clinical practice guidelines in many countries strongly recommend that health care practitioners briefly discuss evidence-based treatment options with all tobacco users at every visit (CAN-ADAPTT, 2011;Fiore et al, 2008;Health, 2007;NICE, 2013;). Practitioners, however, are generally unprepared to effectively discuss treatment options and are unfamiliar with the high intensity of treatment provided by TTSs (Applegate, Sheffer, Crews, Payne, & Smith, 2008;Payne et al, 2014;Sheffer, Anders, Brackman, Steinberg, & Barone, 2012;Steinberg, Alvarez, Delnevo, Kaufman, & Cantor, 2006).…”