(Verbatim from Application) Approximately one-quarter of Americans continue to smoke despite evidence that smoking is the single most important preventable cause of morbidity and mortality. Experimental studies show that physician-delivered interventions can be effective in facilitating quit attempts among smokers and in helping them achieve longer term abstinence. Recent AHRQ practice guidelines emphasize the important role physicians have to play in engaging the broad population of smokers who are not interested in quitting (an estimated 80% of smokers) as well as helping those individuals who are actively considering or in the process of quitting. These guidelines, referred to as the 4 """"""""A's"""""""" capitalize on the fact that the medical visit represents a critical """"""""teachable moment"""""""" for the delivery of messages about smoking and the majority of smokers (65-70%) see a primary care physician annually. Few physicians, however, routinely adhere to these guidelines due to such factors as lack of confidence in their ability to perform counseling-related activities, time constraints during the office visit, and anticipated resistance from smokers. Our proposed initiative, which combines in-person physician smoking cessation training with computer-generated recommendations tailored to the individual smoker's stage of readiness to quit, seeks to address these key barriers to physician performance of the 4 """"""""A's"""""""" as well as capitalize on the powerful influence physicians exert during the """"""""teachable moment"""""""" afforded by the primary care office visit. Four different conditions are compared in this study. The first condition is usual care. The second is a nonspecific treatment condition in which physicians receive brief in-office training on how to adhere to the 4 """"""""A's"""""""" and stage-based smoking cessation pamphlets to distribute to smokers. The other remaining conditions also provide physicians with pamphlets, but augment the nonspecific training with instructions on the use of an """"""""expert system report"""""""" a computer-generated document that profiles the smoker's stage of readiness to quit smoking, his/her perceived pros and cons of quitting, and quitting strategies. These strategies are designed to assist the augmented training as well as a copy of an expert system report prior to an office visit with a smoker. In the third condition, """"""""Expert M.D."""""""" physicians will receive the augmented training as well as a copy of an expert system report prior to an office visit with a smoker. In condition 4, """"""""Expert M.D./Pt.,"""""""" both the physician and the smoker will receive the expert system report just prior to the medical visit. One hundred twenty primary care physicians will be randomly assigned to one of the four treatment conditions. Approximately 12 smokers will be recruited per physician participant. Both physicians and patients will be members of Oxford Health Plans, Inc., a large managed care organization.
Study aims are to (1): assess the impact of the interventions on physician adherence to AHRQ smoking cessation practice guidelines and patient smoking quit rates; and (2) to assess intervention cost-effectiveness.
| Redd, William H (2004) Commentary: The evolution of evidence-based psychotherapy. J Clin Psychol 60:443-6 |
