Increasing the efficacy of physician-delivered smoking interventions

Ockene, Judith K.; Kristeller, Jean L.; Goldberg, Robert J.; Amick, Terrence L.; Pekow, Penelope S.; Hosmer, David W.; Quirk, Mark E.; Kalan, Kathryn L.

doi:10.1007/bf02599381

Cited by 239 publications

(94 citation statements)

References 25 publications

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“…We believe the results of this study are applicable to any multiphysician office practice in which patient volume is high and there is a mix of HMO and fee-for-service patients. Although this article describes an alcohol-counseling intervention, we have demonstrated similar outcomes with smoking, 28 and dietary behavior. 18 It also is likely that our findings would apply to other brief, provider-delivered office interventions such as for exercise.…”

Section: Discussionmentioning

confidence: 75%

Alcohol counseling

et al. 1998

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OBJECTIVE:To assess the use of a brief provider-delivered alcohol counseling intervention of 5 to 10 minutes with highrisk drinking patients by primary care providers trained in the counseling intervention and provided with an office support system. DESIGN:A group randomized study design was used. Office sites were randomized to either a usual care or special intervention condition, within which physicians and patients were nested. The unit of analysis was the patient. SETTING:Primary care internal medicine practices affiliated with an academic medical center. PARTICIPANTS:Twenty-nine providers were randomized by practice site to receive training and an office support system to provide an alcohol counseling special intervention or to continue to provide usual care. INTERVENTION:Special intervention providers received 2 1/2 hours of training in a brief alcohol-counseling intervention and were then supported by an office system that screened patients, cued providers to intervene, and made patient education materials available as tip sheets. MEASUREMENTS AND MAIN RESULTS:Implementation of the counseling steps was measured by patient exit interviews (PEI) immediately following the patient visit. The interval between the date of training and the date of the PEI ranged from 6 to 32 months. Special intervention providers were twice as likely as usual care providers to discuss alcohol use with their patients. They carried out every step of the counseling sequence significantly more often than did usual care providers ( p Ͻ .001). This intervention effect persisted over the 32 months of follow-up. CONCLUSIONS:Physicians and other health-care providers trained in a brief provider-delivered alcohol intervention will counsel their high-risk drinking patients when cued to do so and supported by a primary care office system.

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Section: Discussionmentioning

confidence: 75%

Alcohol counseling

et al. 1998

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“…This method has been associated with significantly more change in dietary behavior, 18 smoking behavior, 19 and reduced high-risk drinking at 6-month follow-up when compared to usual primary care. 20 Project Health is a controlled clinical trial that compares a special intervention (SI) consisting of patient-centered counseling for high-risk drinkers to usual care (UC) in the primary care setting.…”

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confidence: 96%

“…Our past research has demonstrated that screening, brief provider-delivered patient-centered counseling, and prompting providers to intervene has a significant effect on change in health-related behaviors 18,19 when used in the primary care setting during regular primary care visits. This method has been associated with significantly more change in dietary behavior, 18 smoking behavior, 19 and reduced high-risk drinking at 6-month follow-up when compared to usual primary care.…”

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confidence: 99%

Brief physician and nurse practitioner-delivered counseling for high-risk drinking

et al. 2005

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Background: The objective of this study was to determine the effects of a brief primary care provider–delivered counseling intervention on the reduction of alcohol consumption by high‐risk drinkers. The intervention was implemented as part of routine primary care medical practice. Methods: We performed a controlled clinical trial with 6‐ and 12‐month follow‐up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high‐risk drinking. A fourth site was added later. From the group that was screened, 530 high‐risk drinkers entered into the study, with 447 providing follow‐up at 12 months. The intervention consisted of brief (5–10 minute) patient‐centered counseling plus an office system that cued providers to intervene and provided patient educational materials. Results: At 12‐month follow‐up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=−5.7 drinks per week; UC=−3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC. Conclusions: Project Health provides evidence that screening and very brief (5–10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high‐risk drinkers.

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“…We estimated the quit responses based on the expected quit responses reported in the literature for the various levels of service and on the previous results reported by the services for level 1 (enrollment and Quit Line use with usual quit rate of 25%), level 2 (brief intake and information only with usual quit rate of 15%), and level 0 (no intake and clinician advice alone with usual quit rate of 10%). 7,11,29,[31][32][33] Measures and Outcomes Key measures and outcomes included (1) changes from baseline to postintervention (18 months) in clinician referrals in both intervention and control groups, (2) estimated quit responses of referred smokers, and (3) estimated incremental costs of the feedback intervention. …”

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confidence: 99%

Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

Wadland¹,

Holtrop²,

Weismantel³

et al. 2007

The Annals of Family Medicine

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PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses. METHODSWe conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated.RESULTS Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P <.001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, n = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P <.001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices.CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs. INTRODUCTIONS moking cessation interventions have proved to be effective in primary care settings according to the systematic reviews of controlled clinical trials that resulted in Clinical Practice Guidelines on Smoking Cessation by the Public Health Service.1,2 Clinicians report various reasons for not following the guidelines, such as focusing on acute or chronic care rather than preventive care, having little training in giving brief advice to quit smoking, and not being subject to accountability or feedback. 3,4 Survey fi ndings show that physicians understand the importance of smoking cessation and espouse its value, but they often do not implement the key elements of offi ce-based methods. 3,4 Physicians rarely schedule smokers for follow-up visits or arrange referrals for support services.1,3-5 Several community-based and health-system-based studies have shown fairly high rates of long-term smoking cessation (20% to 36%) by combining physician identifi cation, advice, and referral for follow-up care with telephone support counseling. [6][7][8][9][10][11] Telephone counseling services for smoking cessation (quit lines) have become widely available through health plans and state or national services, 12 but they are often underutilized. Methods to enhance clinician referrals to quit-line services are needed. 136 TOBACCO C ES S AT ION QUI T L INEFeedback on clinical performance has been studied in numerous randomized clinical trials and reported in systematic reviews to have modest effects.13 Comparing personal performance with peer performance should be a powerful motivator ...

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Increasing the efficacy of physician-delivered smoking interventions

Cited by 239 publications

References 25 publications

Alcohol counseling

Alcohol counseling

Brief physician and nurse practitioner-delivered counseling for high-risk drinking

Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

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