Smoking cessation in primary care clinics

Jeffrey M. Sippel, Molly Osborne, Wendy Bjornson, Bruce Goldberg, A (Sonia) Buist

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

OBJECTIVES: To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements. DESIGN: Randomized clinical trial. SETTING: Two university-affiliated community primary care clinics. PATIENTS: Two hundred five smokers with routinely scheduled appointments. INTERVENTION: All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements. MEASUREMENTS AND MAIN RESULTS: Quit rate was evaluated at 9- month follow-up. Eleven percent of smokers were sustained quitters at follow- up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy (p = .05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%. CONCLUSIONS: The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.

Original languageEnglish (US)
Pages (from-to)670-676
Number of pages7
JournalJournal of General Internal Medicine
Volume14
Issue number11
DOIs
StatePublished - 1999

Fingerprint

United States Agency for Healthcare Research and Quality
Smoking Cessation
Spirometry
Primary Health Care
Guidelines
Nicotine
Carbon Monoxide
Education
Insurance
Appointments and Schedules
Therapeutics
Randomized Controlled Trials
Physicians
Costs and Cost Analysis
Control Groups

Keywords

  • AHCPR guidelines
  • Clinical trial
  • Nicotine replacement therapy
  • Smoking cessation
  • Spirometry

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Smoking cessation in primary care clinics. / Sippel, Jeffrey M.; Osborne, Molly; Bjornson, Wendy; Goldberg, Bruce; Buist, A (Sonia).

In: Journal of General Internal Medicine, Vol. 14, No. 11, 1999, p. 670-676.

Research output: Contribution to journalArticle

Sippel, Jeffrey M. ; Osborne, Molly ; Bjornson, Wendy ; Goldberg, Bruce ; Buist, A (Sonia). / Smoking cessation in primary care clinics. In: Journal of General Internal Medicine. 1999 ; Vol. 14, No. 11. pp. 670-676.
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abstract = "OBJECTIVES: To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements. DESIGN: Randomized clinical trial. SETTING: Two university-affiliated community primary care clinics. PATIENTS: Two hundred five smokers with routinely scheduled appointments. INTERVENTION: All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements. MEASUREMENTS AND MAIN RESULTS: Quit rate was evaluated at 9- month follow-up. Eleven percent of smokers were sustained quitters at follow- up. Sustained quit rate was no different for intervention and control groups (9{\%} vs 14{\%}; [OR] 0.6; 95{\%} [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95{\%} CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy (p = .05). Historical data from previously published studies showed that 2{\%} of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5{\%}. CONCLUSIONS: The sustained smoking cessation rate achieved by following AHCPR guidelines was 11{\%} at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.",
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