Smoking screening and management in primary care practices

Area of Science:

• Primary Care Medicine
• Public Health
• Behavioral Science

Background:

• Smoking remains a leading cause of preventable morbidity and mortality.
• Effective smoking cessation interventions are crucial for improving patient outcomes.
• Primary care physicians play a vital role in identifying and assisting patients who smoke.

Purpose of the Study:

• To assess the current practices of primary care physicians in screening and managing patients who smoke.
• To identify practice-level factors associated with the provision of smoking cessation services.
• To evaluate the effectiveness of current screening and intervention methods in primary care.

Main Methods:

• A descriptive study utilizing physician and patient questionnaires.
• Retrospective review of medical records from 45 primary care practices in the Midwest.
• Inclusion of 160 physicians and 4879 adult patients.

Main Results:

• High rates of patient-reported screening for smoking (81% overall, 93% for recent smokers).
• Increased rates of advice to quit, quit date discussion, and cessation aid receipt compared to previous reports.
• Patients with coronary heart disease (CHD) or risk factors, heavier smokers, frequent visitors, and those desiring help received more services.
• Few practices had systematic processes for smoking cessation, and lack of systems correlated with fewer interventions.

Conclusions:

• Physician screening for smoking is more prevalent than previously reported.
• While patients are often asked about smoking, status is not consistently documented or updated.
• Significant physician variability exists in screening and interventions; evidence-based methods for service improvement are underutilized.