UC DAVIS (US)—Health-care providers are quick to advise patients to quit smoking, but few follow up with programs, plans, or prescriptions to help them break the habit, as recommended by national guidelines.
Elisa K. Tong, assistant professor of medicine at University of California at Davis, surveyed seven groups of health professionals whom smokers are most likely to encounter: primary-care physicians, emergency-medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists.
“We know that provider advice is one of the simplest and most important things to help a smoker to try to quit and stay quit,” Tong says.
“Providers are not doing enough. It should be a priority for all health professionals, not just primary-care physicians.”
The study asked participants if they perform the ‘5 A’s’ with patients: asking, advising, assessing, assisting, and arranging follow-up about tobacco use. Respondents were also asked questions about their own smoking habits.
Participants cited numerous barriers to compliance with the guidelines, including their own tobacco use, perceptions of patient attitudes about quitting, a lack of training in smoking-cessation interventions, and a sense that it was not part of their professional responsibilities.
Details appear online in Nicotine & Tobacco Research, and will be published in the July issue of the journal.
“This paper presents two important findings,” says Steven A. Schroeder of the Division of General Internal Medicine and Smoking Cessation Leadership Center at the University of California at San Francisco, who contributed to the study.
“First, although clinicians could play an important role in helping smokers quit, far too often they do not do so. Second, clinicians themselves have very low smoking rates.
“Even nurses, who were previously assumed to be heavy smokers, are substantially below the national average. If the entire country smoked at the rate of health professionals, the United States would be one of the healthiest nations in the world.”
The study found that 13 percent of registered nurses smoke, fewer than the national prevalence of 20 percent, but far more than other categories of health professionals.
Up to 99 percent of health professionals report that they ask patients and almost as many advise them about smoking risks. But far fewer help them get the help they need to quit.
For example, among registered nurses, 87 percent reported asking if a patient smokes, and 65 percent said they advise smokers to quit. But only 25 percent of respondents reported assisting smokers to set a quit date.
The low rate of assistance for patients was similar across the board, except among primary-care physicians, who report assisting patients to set a quit date nearly 60 percent of the time.
Tong says primary-care physicians have been the main focus for smoking-cessation efforts, but are insufficient to help most smokers quit. Non-physician health professionals can be effective, she says, and that being asked about smoking by more than one type of health professional can increase the odds of a patient quitting.
Tong notes that smoking prevalence among mental health patients is high, and that emergency room physicians are often on the front line of health care, but neither group sufficiently follows the guidelines.
Referring to telephone “quitlines” such as the national 1-800-QUIT NOW is one way all health professionals can improve in assisting smokers to quit.
“Those are missed opportunities if they don’t address tobacco use,” she says.
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