Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial.
ABSTRACT To evaluate the effectiveness of two teaching interventions to increase residents' performance of smoking cessation counseling.
Randomized controlled factorial trial.
Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals.
261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months.
Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.
Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5-1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76-79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3-8.2%; biochemically verified: 3.4-5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.
A simple and feasible educational intervention can increase residents' smoking cessation counseling.
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ABSTRACT: Patients in treatment for substance-use disorders tend to smoke at higher rates than the general population. However, despite the fact such patients may be interested in smoking cessation and have been shown to be able to quit successfully without jeopardizing their sobriety, clinicians are often reluctant to advise their patients to stop smoking. The purpose of this paper is to review factors associated with the adoption of tobacco treatment interventions (TTIs) in the general population and among patients in recovery. We attempt to identify barriers to TTI use and determine where interventions should be directed. Studies were collected using various computerized databases and in consultation experts on tobacco control. We conclude that obstacles to TTI adoption involve the interaction of individual clinician, organizational, and environmental factors, and that changes in all three are needed to increase TTI adoption among substance abuse treatment clinicians. Finally, we offer suggestions regarding where future research is warranted.Drugs: Education Prevention and Policy 02/2004; 11(1):1-20. DOI:10.1080/0968763031000105038 · 0.53 Impact Factor
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ABSTRACT: Objectives: To evaluate the impact on smoking status documentation of a payer-sponsored pay-for-performance (P4P) incentive that targeted a minority of an integrated healthcare delivery system's patients. Study Design: Three commercial insurers simultaneously adopted P4P incentives to document smoking status of their members with 3 chronic diseases. The healthcare system responded by adding a smoking status reminder to all patients' electronic health records (EHRs). We measured change in smoking status documentation before (2008-2009) and after (2010-2011) P4P implementation by patient P4P eligibility. Methods: The P4P-eligible patients were compared primarily with a subset of non-P4P-eligible patients who resembled P4P-eligible patients and also with all non-P4P-eligible patients. Multivariate models adjusted for patient and provider characteristics and accounted for provider-level clustering and preimplementation trends. Results: Documentation increased from 48% of 207,471 patients before P4P to 71% of 227,574 patients after P4P. Improvement from 56% to 83% occurred among P4P-eligible patients (adjusted odds ratio [AOR], 3.6; 95% confidence interval [CI], 2.9-4.5) and from 56% to 80% among the comparable subset of non-P4P-eligible patients (AOR, 3.0; 95% CI, 2.3-3.9). The difference in improvement between groups was significant (AOR, 1.3; 95% CI, 1.1-1.4; P = .009). Conclusions: A P4P incentive targeting a minority of a healthcare system's patients stimulated adoption of a systemwide EHR reminder and improved smoking status documentation overall. Combining a P4P incentive with an EHR reminder might help healthcare systems improve treatment delivery for smokers and meet "meaningful use" standards for EHRs.The American journal of managed care 07/2013; 19(7):554-61. · 2.17 Impact Factor