Elsevier

Preventive Medicine

Volume 35, Issue 6, December 2002, Pages 572-583
Preventive Medicine

Regular Article
Improving Family Physicians' Use of Evidence-Based Smoking Cessation Strategies: A Cluster Randomization Trial

https://doi.org/10.1006/pmed.2002.1111Get rights and content

Abstract

Background. Family physicians (FPs) in Australia underutilize effective strategies to help patients stop smoking. We conducted a cluster randomization trial to evaluate a multifaceted, practice-based intervention involving audit, feedback, and academic detailing to improve FP smoking cessation advice.

Methods. Sixty FPs in 39 practices participated. FPs' provision of smoking cessation advice was measured by patient recall, medical record audit, and FP self-report. Logistic regression analysis using generalized estimating equations was performed to assess improvements in practice, after adjustment for clustering by practice.

Results. Improvements between baseline and posttest in patient recall of FP advice about nicotine replacement patches and gum were significantly greater in the intervention than in the control group (P = 0.0056 and P = 0.0002, respectively). While there were substantial increases in patient recall of assessment of smoking status and FP use of “quit dates,” behavioral advice, and written materials in the intervention group, these changes were not significantly greater than those in the control group. Notation of patients' smoking status and smoking cessation advice in medical records remained suboptimal in both groups.

Conclusions. This multifaceted intervention was successful only in promoting FPs' use of nicotine replacement therapy. While the use of other effective cessation strategies appeared to increase, a larger trial is needed for further evaluation.

References (44)

  • CD Mathers et al.

    The Australian Burden of Disease study: measuring the loss of health from diseases, injuries and risk factors

    MJA

    (2000)
  • DJ Hill et al.

    Smoking behaviours of Australian adults: trends and concerns

    MJA

    (1998)
  • US Department of Health and Human Services, The health benefits of smoking cessation: a report of the Surgeon General,...
  • Commonwealth Department of Health and Family Services, General practice in Australia: 1996, Canberra, CDHFS,...
  • Fiore, M, C, Bailey, W, C, Cohen, S, J, et al., Treating tobacco use and dependence. Clinical practice guideline,...
  • J Dickinson et al.

    General practitioners' detection of patients' smoking status

    MJA

    (1989)
  • JM Young et al.

    Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers

    Fam Pract

    (2001)
  • J Cockburn et al.

    Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners

    BMJ

    (1992)
  • Effective Health Care

    (1999)
  • D Davis et al.

    Changing physician performance: a systematic review of the effect of continuing medical education strategies

    JAMA

    (1995)
  • A Oxman et al.

    No magic bullets: a systematic review of 102 trials of interventions to improve professional practice

    CMAJ

    (1995)
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