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Am Fam Physician. 1998;57(5):1140

Approximately 70 percent of smokers contact a physician each year, and each smoker averages more than four visits to a physician annually. Primary care physicians have an ongoing opportunity to help patients stop smoking. Even brief interventions have been shown to increase smoking abstinence at one year of follow-up. Although most physicians believe they are providing smoking cessation advice to their patients, it is reported that only about 51 percent of smokers remember being advised to quit. Goldstein and associates evaluated patients' perceptions of their physicians' efforts to help them stop smoking.

Study subjects were asked to complete a telephone survey. Data were collected for 3,037 smokers who had visited a health care setting during the past 12 months.

Smokers were more likely to report being spoken to about smoking, being advised to quit, being offered help in quitting or having a follow-up visit arranged if they received care in a private physician's office, if they rated their health status as fair or poor, if they had smoked more than a pack a day for a long duration or if they were thinking about quitting. Women were more likely than men and employed persons were more likely than unemployed persons to receive advice to quit. Smokers who rated their health status as fair or poor were more likely to be prescribed medication to help them quit smoking than were those who rated their health as good.

As few as 14.9 percent of the persons surveyed reported being offered help to quit smoking, and 3.0 percent said they were given a follow-up appointment. The data showed that physicians were more likely to offer advice when the smoker expressed a willingness to quit. Thus, primary care physicians who only intervene with smokers who are motivated to quit are missing opportunities to provide counseling about smoking cessation strategies to the majority of their patients who smoke.

The authors suggest that there is considerable room for improvement in physicians' efforts to encourage patients to quit smoking and to provide follow-up visits. The authors note that office systems should be used to enhance identification and treatment of smokers, as recommended in guidelines from the Agency for Health Care Policy and Research.

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Copyright © 1998 by the American Academy of Family Physicians.

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