A POPULATION-BASED SURVEY OF PHYSICIAN SMOKING CESSATION COUNSELING PRACTICES

Background. To be most effective, physicians' smoking cessation interv entions must go beyond advice, to include counseling and follow-up. A full profile of physician performance on the recommended activities to promote smoking cessation has not been provided previously. Methods. We surveyed a representative sample of 246 community-based primary car e physicians who had agreed to participate in a 3-year study to evalua te a strategy for disseminating smoking cessation interventions, based on the National Cancer Institute 4-A model and on the Transtheoretica l Model of Change. Results. A majority reported they Ask (67%) and Adv ise (74%) their patients about smoking, while few go beyond to Assist (35%) or Arrange follow-up (8%) with patients who smoke. The criteria for ''thorough'' counseling was met by only 27% of physicians. More th an half were not intending to increase counseling activity in the next 6 months. After controlling for other variables, physicians in privat e offices were more likely than physicians in HMO or other settings to be active with smoking cessation counseling. General Internal Medicin e physicians were most active, and Ob/Gyn physicians were least active , with smoking cessation counseling among primary care specialty group s. Conclusions. Innovative approaches are needed to motivate, support, and reward physicians to counsel their patients who smoke, especially when considering the movement toward managed health care. Precis: A s urvey of primary care physicians focusing on national guidelines for s moking cessation counseling showed a majority Ask (67%) and Advise (74 %) patients about smoking, but few Assist (35%) or Arrange follow-up ( 8%). (C) 1998 American Health Foundation and Academic Press.