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: A survey of Chinese physicians' cigarette smoking habits and their counselling of patients to quit smoking was carried out in two provincial hospitals in Wuhan, capital city of Hubei province, People's Republic of China. All 559 physicians in the two hospitals were given the questionnaire, of which 86% (480) returned their completed questionnaires. Of the 480 physicians, 50.9% of the males, and 4.8% of the females were current cigarette smokers. The majority of physicians (85.6%) had counselled their patients about cigarette smoking in the past year, although few physicians (2.9%) felt that they were very successful in helping patients to quit smoking. The frequency of physicians' anti-smoking counselling was significantly correlated with a number of variables: physicians' own smoking status; whether they perceived themselves as the most influential people in helping patients to quit smoking; whether physicians thought that they were successful in their past counselling practices; and physicians' age.Health Promotion International 06/1996; 11(2). DOI:10.1093/heapro/11.2.89 · 1.94 Impact Factor
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ABSTRACT: Tobacco use is the chief avoidable cause of death in the United States. Physicians, however, are not routinely assessing this risk and providing counseling for risk reduction. This study examines tobacco cessation counseling practices among family practice residents and explores the determinants of residents' smoking-counseling behaviors and counseling duration. One hundred ten family practice residents (response rate = 93.2%) from four Texas residency training programs completed a survey designed to assess tobacco cessation counseling practices. A high proportion of residents reported that they usually or always assessed tobacco use (59.3%) and advised their patients to quit smoking (80.9%), with a lower proportion reporting specific counseling behaviors (7.3% - 21.9%), referrals (1.8%), or follow-up visits (1.8%). Year of residency, perceived effectiveness, and the interaction between perceived effectiveness and residency year were significantly associated with number of counseling behaviors, and year of residency and perceived effectiveness were significantly associated with counseling duration. Faculty physicians should assist residents to implement the Public Health Service-sponsored clinical practice guideline for tobacco control. There is a need to increase behavioral skills and perceived effectiveness for assessing and counseling smokers among first-year residents.The Journal of the American Board of Family Practice / American Board of Family Practice 14(5):343-51.
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ABSTRACT: This study sought to assess the attitudes, behavior, and demographics of general dentists in the state of Nebraska concerning overall oral care of infants. A 15-item questionnaire and accompanying cover letter were mailed to 800 licensed general dentists in the state of Nebraska. The survey asked for demographic information, the number of years that the dentist had been practicing dentistry, the type of practice, the dentist's additional training (if any), and the dentist's patient base. The survey also asked questions related to a child's first visit to a dental practice. A self-addressed stamped envelope was enclosed for dentists to return the survey. Descriptive statistics and chi-square tests were used to analyze data. Based on the results of this survey, most practitioners reported seeing children; however, only 11.9% saw children before their first birthday. Most practitioners reported performing oral hygiene procedures for young children, but few dentists surveyed provide restorative services. Most dentists reported discussing oral hygiene practices during infant oral health examinations, but few dentists discuss caries risk.General dentistry 58(3):182-7.