Current primary care physician interventions to promote smoking cessation in Israel: an observational study

Smoking continues to be the most significant preventable cause of morbidity and early mortality in the developed world. Primary care physicians are not fufilling their potentially vital and effective role with regard to tobacco use and dependence.

To evaluate current primary care physician practise in promoting smoking cessation.

This observational study evaluated physician recording of smoking status by analysis of patients' electronic medical records. The 126 primary care physicians were based in 23 Tel Aviv clinics treating 144,811 patients. We also assessed additional physician anti-smoking activities by a telephone questionnaire of 178 randomly selected patients.

Analysis of the EMRs revealed that an average of 4.4% of patients per physician were recorded as smokers (as compared to a known smoking rate in this patient population of 24%). Male physicians recorded a significantly higher proportion of their patients as smokers in the EMR compared to female physicians (P < 0.05). A non-significantly higher rate of recording smokers was found in doctors who had completed postgraduate specialization in family medicine as compared to non-specialists. The questionnaire results show that 41% of patients interviewed recalled being asked if they smoked and 31% of smoking patients had been advised to quit. A non-significantly higher proportion of male as compared to female patients reported being questioned if they smoked, and if they were smokers, being advised to quit.

This study shows low rates of physician intervention to promote smoking cessation. It appears that a large proportion of the primary care physicians surveyed do not follow recommendations to promote smoking cessation among their patients. Intervention among adolesent smokers was particularly inadequate. Further action is needed to improve the performance of physicians in aiding smoking cessation.