Physician-Patient Interaction for Smoking Cessation Medications: A Dance of Mutual Accommodation?

Objective: To study physician-smoker interactions around the receipt of smoking cessation medication prescriptions to better understand the low rates of reported assistance and follow-up. Methods: A stratified random sample of smokers recently filling prescriptions for cessation medica-tions was identified for a phone interview about the quitting experience. The transcriptions of those portions of 50 interviews that addressed cessation contacts with clinicians were reviewed by the co-authors and analyzed for quantifiable data, observations, and themes. Results: Although there were low levels of reported physician adherence to the Assist and Arrange recommendations of the Public Health Service 5As clinical guideline for smoking cessation, 27 (55%) of these smokers were quit at 1 to 3 months after the medication fill. Smoker descriptions of the contacts with their physicians about smoking cessation suggested nonconfrontational, collaborative, and satisfy-ing interactions that were flexibly dominated by either party. Physician assistance predominantly con-cerned use of the medication (66%). Conclusions: These physician-smoker interactions seemed to be mutually accommodative. Given the apparent high quit rates and limited evidence of smoker interest in other forms of assistance, perhaps a physician-dominant encounter is not as common or as necessary as has been thought. (J Am Board Fa