THE PHYSICIAN-DELIVERED SMOKING INTERVENTION PROJECT - FACTORS THAT DETERMINE HOW MUCH THE PHYSICIAN INTERVENES WITH SMOKERS

Objective: To determine factors that affect how much physicians traine d to use a patient-centered smoking intervention intervene with their smoking patients. Design: Forty internal medicine residents and ten in ternal medicine attending physicians trained in a patient-centered cou nseling approach were randomized to an algorithm condition (provision of intervention algorithm at each patient visit) or a no-algorithm con dition. Smoking intervention steps used by physicians with patients we re assessed with Patient Exit Interviews (PEIs). Setting: Ambulatory c linic; academic medical center. Patients: Five hundred twenty-seven ad ult smokers seen in clinic between June 1990 and April 1992. Main resu lts: There was no difference in overall PEI scores or in individual PE I steps taken between the algorithm and no-algorithm conditions. Two p atient baseline factors (reporting thinking of stopping smoking within six months and higher Fagerstrom Tolerance Score) and one physician f actor (older age) were significantly predictive of higher PEI score. C onclusion: Provision of an intervention algorithm at each patient visi t does not increase the likelihood that trained physicians who are cue d to intervene will perform more of the intervention steps taught. Tra ined physicians are more likely to intervene with smokers who are more nicotine-dependent and who expect and desire to stop smoking.