Tobacco-Cessation Services and Patient Satisfaction in Nine Nonprofit HMOs (original) (raw)
Related papers
A Population-Based Survey of Physician Smoking Cessation Counseling Practices
Preventive Medicine, 1998
on national guidelines for smoking cessation counsel-Background. To be most effective, physicians' smoking showed a majority Ask (67%) and Advise (74%) paing cessation interventions must go beyond advice, to tients about smoking, but few Assist (35%) or Arrange include counseling and follow-up. A full profile of phyfollow-up (8%). ᭧1998 American Health Foundation and Academic Press sician performance on the recommended activities to Key Words: smoking cessation, primary care, physician characteristics, counseling. promote smoking cessation has not been provided previously. Methods. We surveyed a representative sample of 246 community-based primary care physicians who had INTRODUCTION agreed to participate in a 3-year study to evaluate a Cigarette smoking continues to be the major cause strategy for disseminating smoking cessation intervenof preventable morbidity and mortality [1,2]. Between tions, based on the National Cancer Institute 4-A model the 1960s and the 1980s premature mortality among and on the Transtheoretical Model of Change. white, middle class smokers, compared to that of non-Results. A majority reported they Ask (67%) and Adsmokers, doubled for women and remained unchanged vise (74%) their patients about smoking, while few go for men [3]. Annual smoking-related medical care exbeyond to Assist (35%) or Arrange follow-up (8%) with penditures are estimated at 50 billion dollars [4]. Alpatients who smoke. The criteria for "thorough" counthough smoking prevalence has remained essentially seling was met by only 27% of physicians. More than half were not intending to increase counseling activity unchanged between 1990 (25.5%) [5] and 1995 (24.7%) in the next 6 months. After controlling for other vari-[6], over 68% of current smokers report that they want ables, physicians in private offices were more likely to stop smoking [6]. than physicians in HMO or other settings to be active Primary care physicians can play a key role in the with smoking cessation counseling. General Internal identification, assessment, and treatment of smokers Medicine physicians were most active, and Ob/Gyn [7,8]. Physicians have contact with approximately 70% physicians were least active, with smoking cessation of all smokers each year [9], and the doctor-patient counseling among primary care specialty groups. relationship provides a "unique and powerful" context Conclusions. Innovative approaches are needed to for treatment of nicotine dependence [10]. Primary care motivate, support, and reward physicians to counsel physicians have multiple opportunities to work with their patients who smoke, especially when considering smokers, who average 4.3 visits annually [11]. Morethe movement toward managed health care. over, physician-delivered smoking cessation interven-Précis: A survey of primary care physicians focusing tions are well received and effective [12,13]. Brief physician advice and encouragement during one routine office visit result in a 2% estimated quit rate without
Effect of a pharmacist managed smoking cessation clinic on quit rates
Pharmacy Practice (Internet), 2009
Objective: The purpose of this study was to quantify quit rates, determine factors predicting success, and analyze patients' perceptions at 3 months after participation in the pharmacist-managed Smoking Cessation Group Clinic. Methods: This was a prospective, single group study that was conducted in patients that had participated in the Smoking Cessation Group Clinic at the University of Iowa Hospitals and Clinics. Clinic participants received structured group counseling covering various topics associated with cessation. Varenicline, bupropion and nicotine replacement therapy were used as smoking cessation aids and selection was based on patient preference and absence of contraindications. The primary outcome of this trial was smoking status at 3 months. The patients were contacted by telephone at 3, and 6 months after the start of the clinic and asked about current smoking status. At 3 months, patients were asked to rate on a Likert scale of 1 to 5 (1=not helpful; 5=very helpful) their perceptions of individual aspects of the clinic and on a scale of 1 to 10 (1=not helpful; 10=very helpful) how they perceived their cessation aid. Results: From February 2007 to January 2008, 21 patients enrolled in the intent-to-treat follow up study. Analysis of data was completed in August 2008. At 3 and 6 months, 47.6% and 52.4%, of patients reported being smoke-free, respectively. At 3 months, factors consistent with success included having more previous quit attempts and type of cessation aid used. These endpoints continued to be significant at 6 months, in addition to attending more clinic sessions, and type of insurance (favoring private insurance). Patients who quit smoking rated their cessation aid as more helpful than those who did not quit smoking (8.56; SD=0.88 verses 6.71; SD=2.81, respectively; p=0.14). The *
Physician smoking-cessation actions: Are they dependent on insurance coverage or on patients?
American Journal of Preventive Medicine, 2002
Background: Despite good evidence that their smoking-cessation actions can be very effective, physicians have not consistently used the 5A actions (being asked, advised, assessed, assisted, and arranged) recommended in the U.S. Public Health Service tobacco guidelines. We tested the hypothesis that the introduction of coverage for smoking-cessation pharmacotherapy by the health plans covering most of the population in one region would increase physician use of 5A's. Methods: A cohort of smoking members of two health plans was surveyed before and after the introduction of coverage for smoking cessation. A total of 1560 current smokers with a physician visit in the last year responded to both surveys. The key outcome measures were smoker reports of the guideline 5As for smoking-cessation support during the last physician visit. Results: There were small significant absolute percentage increases only for reports of being assessed (ϩ4.9%, pϭ0.01) and assisted (set quit date ϩ6.5%, pϭ0.0004); encouraged to use medications (ϩ8.8%, pϭ0.03); and given a prescription (ϩ8.6%, pϭ0.0005). However, these increases were limited to smokers reporting awareness of the coverage, asking for quitting help, or both. Conclusion: Coverage for pharmacotherapy alone appears to have had no effect on physician behavior beyond that stimulated by smokers who were aware of the coverage, perhaps because they raised the issue. More research is needed on this suggestion that patients create physician behavior change.
Journal of the National Cancer Institute Monographs, 2005
Background: This project examined tobacco policies and delivery of cessation services in nonprofi t HMOs that collectively provide comprehensive medical care to more than 8 million members. Methods: Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399 -528 at each of nine health plans). Results: Of these smokers, 71% reported advice to quit, 56% were asked about their willingness to quit, 49% were provided some assistance in quitting (mostly self-help material or information about classes or counseling), and 9% were offered some kind of follow-up. Smokers receiving assistance in quitting reported higher satisfaction with their care. Conclusions: In general, health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care. Compared with tobacco control efforts of a decade or more ago, considerable progress has been made. However, there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting. [J Natl Cancer Inst Monogr 2005;35:75 -80]
Physician smoking-cessation actions
American Journal of Preventive Medicine, 2002
Background: Despite good evidence that their smoking-cessation actions can be very effective, physicians have not consistently used the 5A actions (being asked, advised, assessed, assisted, and arranged) recommended in the U.S. Public Health Service tobacco guidelines. We tested the hypothesis that the introduction of coverage for smoking-cessation pharmacotherapy by the health plans covering most of the population in one region would increase physician use of 5A's.
Preventive Medicine Reports, 2018
The study investigated the over-time changes and racial/ethnic disparities in the quality of health care services for cigarette smoking cessation in the U.S. from 2007 to 2015. The primary measures included receiving a doctor's advice to quit smoking in the year before smoking cessation and using behavioral interventions for smoking cessation (telephone helplines and web-based interventions) while trying to quit smoking. The study was conducted from January to July 2018. We used merged data from the 2010-11 and 2014-15 Tobacco Use Supplement to the Current Population Survey. The sample sizes were 7011 and 12,025, respectively, for the analyses corresponding to two primary measures. The rate of receiving a doctor's advice to quit increased significantly from 66% (SE = 2%) in 2007 to 73% (SE = 4%) in 2015. The rate of usage of telephone helplines or web-based interventions for smoking cessation increased only from 3% (SE = 1%) in 2007 to 5% (SE = 1%) in 2015. These positive trends remained even after adjusting for several important factors. For both measures, the rates were consistently lower among Hispanic smokers than Non-Hispanic Black/African American and White smokers. Despite the availability of states' behavioral interventions for cessation of tobacco use, utilization of these interventions remains very low, indicating that smokers may not be aware of these free resources, may have misconceptions about these interventions being evidence-based, or there are barriers for using these interventions.
The Journal of the American Board of Family Medicine, 2013
Primary care practices are an ideal setting for reducing national smoking rates because >70% of smokers visit their physician annually, yet smoking cessation counseling is inconsistently delivered to patients. We designed and created a novel software program for handheld computers and hypothesized that it would improve clinicians' ability to provide patient-tailored smoking cessation counseling at the point of care. A handheld computer software program was created based on smoking cessation guidelines and an adaptation of widely accepted behavioral change theories. The tool was evaluated using a validated before/after survey to measure physician smoking cessation counseling behaviors, knowledge, and comfort/self-efficacy. Participants included 17 physicians (mean age, 41 years; 71% male; 5 resident physicians) from a practice-based research network. After 4 months of use in direct patient care, physicians were more likely to advise patients to stop smoking (P = .049) and reported an increase in use of the "5 As" (P = .03). Improved self-efficacy in counseling patients regarding smoking cessation (P = .006) was seen, as was increased comfort in providing follow-up to patients (P = .04). Use of a handheld computer software tool improved smoking cessation counseling among physicians and shows promise for translating evidence about smoking cessation counseling into practice and educational settings.