What do Patients Receive: Results of a Survey of Health Practitioners and Smoking Cessation Practices

Health care providers play an important role in encouraging cessation among their patients who use tobacco, especially in rural or remote areas where other cessation assistance options may not be available. Agency for Health Care Policy and Research guidelines for clinicians recommend the "5 As" approach to helping patients with tobacco cessation: Ask, Advise, Assess, Assist, and Arrange follow-up. Research indicates that tobacco users both expect and desire tobacco cessation discussions with their health care providers, and are more likely to make a quit attempt as a result, leading to more positive health outcomes. However, despite the recommendation that all practitioners provide cessation advice to their patients who use tobacco, practices fall short of this goal. To determine health care provider adherence to the clinical guidelines in Iowa, lists of physicians, dentists, nurse practitioners, physician assistants and pharmacists were obtained from each group's state licensure board. A random sample of 3000 providers was selected, with oversampling of smaller counties that had fewer health care providers. A survey was sent to each subject. Respondents included 433 physicians, 253 dentists, 120 nurse practitioners, 119 physician assistants, and 161 pharmacists. Socio-demographic variables (e.g., gender, smoking status, graduation year) and job-related variables (e.g., provider type, size of community served, number of patients per day) were assessed for impact on provider adherence to the clinical guidelines. Each provider group's adherence to the guidelines and comparisons among groups will be presented, and strategies for improving smoking cessation treatment will be discussed