ORLANDO – Cigarette sales may be at a 55-year low, but such favorable news is probably not due to efforts among physicians to counsel patients to stop smoking.
In fact, physicians broach the topic with smokers during only 1 in 5 office visits, according to a nationwide survey of primary care and specialist physicians.
From their perspective, providers noted that time constraints during the typical office visit and the belief that smokers aren't likely to change their behavior contributed to their inaction.
Physicians who responded to a 2001–2003 national survey reported counseling smokers in 20% of visits, compared with 21% of smokers' visits in a 1994–1996 survey, Dr. Anne N. Thorndike of Massachusetts General Hospital, Boston, reported at the annual meeting of the Society for Research on Nicotine and Tobacco.
And there was only slight improvement in the identification of smokers, she said. In the later survey, physicians reported identifying smoking status during 68% of all visits, compared with 66% of visits in the earlier survey.
The data come from the National Ambulatory Medical Care Survey, an annual assessment of office-based physicians in the United States who see adult patients. The researchers compared 2001–2003 survey data on 58,991 visits with 1994–1996 survey data on 84,104 visits.
The analysis showed that physicians did increase their prescriptions for cessation medications. In 1994–1996, physicians reported prescribing cessation medications during 0.8% of smokers' visits. That figure rose to 1.7% in 2001–2003. The majority of the increase was due to the availability of bupropion, Dr. Thorndike noted.
Primary care physicians were almost twice as likely to offer counseling as were specialists, but as unlikely to identify smokers, she said. Pregnancy increased the likelihood of identification of smoking status but did not increase the likelihood that smokers would be counseled about quitting.
A separate survey of physicians and other health care providers in a Washington state HMO network found that while almost all physicians surveyed said they identify smoking status and discuss it with their patients, fewer report taking any further action.
Anne Perez-Cromwell and her colleagues at Free & Clear Inc. in Seattle mailed a survey to 250 physicians and other providers and received 105 responses. Nearly half of the providers surveyed were family medicine physicians, 15% were internists, and the other providers included family medicine and internal medicine nurse practitioners and physician assistants.
Nearly all providers (97%) said that they made a point of discussing smoking with all patients who smoke, regardless of their health status or interest in quitting.
But only 69% said they referred patients to either the HMO's tobacco cessation program administered by Free & Clear, or the state's quit line. About 15% of respondents said they were aware of treatment resources but did not refer patients, and 16% said they were not aware of the programs.