SMOKING-CESSATION STRATEGIES OBSERVED IN VIDEOTAPED GENERAL-PRACTICE CONSULTATIONS

Background: This study describes opportunistic smoking-cessation couns eling and compares strategies used in general practice to experts' rec ommendations. Methods: In this observational study we analysed 157 vid eotaped consultations with self-reported smokers, visiting 70 Australi an general practitioners (GPs) who were randomly enrolled in the Victo rian General Practice Study. Smoking-cessation strategies were analyse d using a rating form assessed for intrarater reliability and compared to recommendations of 20 experts surveyed to ascertain effective and feasible strategies. Results: GPs identified smokers in 32% of consult ations and counselled them in 29%. Median counselling time was 44 seco nds in encounters typically lasting 10 minutes. When smoking was raise d, advice to quit, personalising risks, discussing health risks, and q uantifying consumption were the most commonly used strategies (46%-54% ). Assessment of motivation to quit, individualised education, practic al hints to stop, written materials, and followup were observed in a t hird or less of interventions. Quit dates and nicotine replacement wer e never proposed. Conclusions: GPs miss many opportunities to advise s mokers to quit and rarely use effective smoking-cessation techniques a s recommended. Medical education has failed to provide GPs with skills to counsel smokers routinely and effectively. We recommend better tra ining of GPs in effective smoking-cessation strategies and incentives to facilitate their implementation in practice.