Direct observation of smoking cessation activities in primary care practice

OBJECTIVE Our goals were to determine how often family physicians incorpora te smoking cessation efforts into routine office visits and to examine the effect of patient, physician, and office characteristics on the frequency o f these efforts. STUDY DESIGN Data was gathered using direct observation of physician-patien t encounters, a survey of physicians, and an on-site examination of office systems for supporting smoking cessation. POPULATION We included patients seen for routine office visits in 38 primar y care physician practices. OUTCOMES MEASURED The frequency of tobacco discussions among all patients, the extent of these discussions among smokers, and the presence of tobacco- related systems and policies in physicians' offices were measured. RESULTS Tobacco was discussed during 633 of 2963 encounters (21%; range amo ng practices = 0%-90%). Discussion of tobacco was more common in the 58% of practices that had standard forms for recording smoking status (26% vs 16% ; P=.01). Tobacco discussions were more common during new patient visits bu t occurred less often with older patients and among physicians in practice more than 10 years. Of 244 smokers identified, physicians provided assistan ce with smoking cessation for 38% (range among practices = 0%-100%). Buprop ion and nicotine-replacement therapy were discussed with smokers in 31% and 17% of encounters, respectively. Although 68% of offices had smoking cessa tion materials for patients, few recorded tobacco use in the "vital signs" section of the patient history or assigned smoking-related tasks to nonphys ician personnel. CONCLUSIONS Smoking cessation practices vary widely in primary care offices . Strategies are needed to assist physicians with incorporating systematic approaches to maximize smoking cessation rates.