Cigarette smoking kills hundreds of thousands of Americans each year and is the leading cause of preventable death in the United States. Many smokers' only point of contact with the health care system is through their primary care physician, most often for reasons unrelated to smoking. Family physicians, then, play a key role in identifying smokers and developing effective strategies to help them quit.
Although a majority of patients report being asked about their smoking status by their primary care physicians, only a small percentage of smokers report receiving specific advice or treatment plans. Yet research has shown that even brief smoking-cessation advice can make a difference. Patients who receive just three minutes or less of smoking-cessation advice from their physicians are more likely to quit than those who receive no counseling at all.1
An analysis from the Direct Observation of Primary Care (DOPC) Study2 evaluated the incidence of smoking-cessation counseling by family physicians and the types of visits during which such counseling occurs. Among 2,655 directly observed visits to 138 family physicians in northeast Ohio, physicians provided smoking-cessation counseling to one-quarter of identified smokers. (Given that the average patient in the study visited his or her physician four times each year, the potential impact of this rate of advice is significant.) The average duration of advice was less than 90 seconds.
Illuminating the ‘black box’ of primary care
This article continues our series offering practical lessons from the Direct Observation of Primary Care (DOPC) Study, which was funded by the National Institutes of Health and conducted by the Center for Research in Family Practice and Primary Care, with support from the AAFP. The study demonstrates the complexities of the patient visit, the demands of real-world practice and the value of primary care, issues that policymakers, the public and even clinicians have not fully understood. Researchers used a multi-method approach, including direct observation, to study 4,454 patient visits to 138 family physicians in 84 practice sites.
Family physicians were most likely to provide advice for smoking cessation during visits for well care (55 percent). In chronic illness visits, smoking-cessation advice was delivered more frequently for tobacco-related ailments (32 percent), such as cardiac, pulmonary and vascular diseases, than for other chronic illnesses (17 percent).
What the study tells us is that, although the rate of advice can and should be improved, family physicians do provide brief smoking-cessation advice that is targeted toward patient risk factors. Viewing patient visits as opportunities to provide specific, brief advice about smoking cessation, and targeting this advice to high-risk patients and “teachable moments” (such as tobacco-related illnesses), can increase the potential effectiveness of smoking-cessation counseling, without “busting” a physician's schedule. In fact, if a clinician provided targeted one-minute advice for all smokers, it would take less than 10 minutes a day for a clinician who sees 24 patients a day. Most importantly, it would have a major impact on the health of those patients.