SMOKING CESSATION INTERVENTIONS IN RURAL FAMILY PRACTICES - AN UPRNETSTUDY

BACKGROUND. Primary care physicians are urged to offer smoking cessati on counseling to their patients. Many studies have sought to determine which smoking interventions are most effective in medical office sett ings. As a result, routine identification of smokers, brief counseling , referral to smoking cessation programs, and nicotine replacement the rapy are advocated. The context of patient visits during which smoking cessation advice is given, however, has received little attention. Th e objective of this study was to determine if patients' reasons for vi sits and self-reported readiness to quit smoking are associated with l ikelihood and type of smoking cessation intervention offered by family physicians. METHODS. The study was conducted in the Upper Peninsula R esearch Network (UPRNet), a voluntary association of family physicians in 15 medical clinics located in rural areas of northern Michigan. Pr actice coordinators administered a 1-page exit questionnaire to every other adult patient seen by a participating physician immediately afte r the office visit. Clinicians were blinded to the specific purpose of the questionnaire. During the study, 2317 questionnaires were adminis tered, yielding information on 455 smokers. RESULTS. The overall rate of physicians' providing any smoking cessation intervention at any typ e of visit was 47%. There was a significant association between freque ncy of smoking cessation intervention and reasons for visits (chi(2)=1 0.46, P =.01). There was a statistically significant difference betwee n stages of readiness to quit and frequency of smoking cessation inter vention offered (chi(2)=26.5, P <.001). Clinicians offered smoking ces sation interventions to smokers in the precontemplative stage signific antly less often than to smokers in the contemplation, preparation, or action stages. CONCLUSIONS. UPRNet practitioners vary the frequency o f smoking cessation interventions according to patients' reasons for t he medical visit and their readiness to quit smoking.