US physicians' treatment of smoking in outpatients with psychiatric diagnoses

A 1996 American Psychiatric Association (APA) guideline recommends the routine treatment of smoking for patients with psychiatric diagnoses. This study evaluates how often US physicians identified and treated smoking among these patients in the ambulatory setting just prior to publication of this guideline, by analysis of 1991-1996 data from the National Ambulatory Medical Care Survey, an annual survey of a random sample of US office-based physicians. Physicians were more likely to identify the smoking status of patients with psychiatric diagnoses compared to patients without these diagnoses (76% vs. 64% of visits, p<0.0001). Smokers with psychiatric diagnoses were more likely to be counseled about smoking than were smokers with non-psychiatric diagnoses (23% vs. 18% of visits, p<0.0001), although the absolute difference was small. Primary care physicians counseled smokers with psychiatric diagnoses more often than did psychiatrists, but both groups of physicians counseled at less than half of smokers' visits. All physicians were more likely to counsel smokers with the diagnosis of anxiety but less likely to counsel smokers with the diagnosis of an affective disorder compared to smokers without these diagnoses. Physicians usually identified the smoking status of patients with psychiatric diagnoses but infrequently acted on this information by counseling smokers to quit. Physicians are missing an important opportunity to prevent tobacco-related morbidity and mortality among this group of patients.