Counseling by healthcare providers increases rates of smoking cessation rates, yet <50% of patients who smoke receive cessation counseling during physician office visits. Evidence-based recommendations for tobacco cessation treatment are available in Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline.
The recommendations include asking about tobacco use at every office visit, advising those who use tobacco to quit, assessing readiness to quit, assisting with quitting, and arranging follow-up (the 5 A’s model: ask, advise, assess, assist, and arrange [follow-up]). Pharmacists are also in a position to have an effect on smoking cessation success rates. Because seeking advice from a pharmacist does not require an appointment or healthcare insurance, pharmacists are able to reach underserved populations where there is often a higher prevalence of tobacco use, creating a disproportionately higher incidence of tobacco-related diseases. Researchers recently conducted a study to evaluate the impact of 2 continuing education programs designed to improve confidence and skills in cessation counseling for physicians and pharmacists. They reported study results in Archives of Internal Medicine [2010;170(18):1640-1646].
The study was a group-randomized trial of healthcare providers from 16 communities in Texas. Participants included 87 physicians and 83 pharmacists. Smoking cessation training (intervention group) was compared with skin cancer prevention training (control group). Outcome assessments included counseling and treatment practices reported by healthcare providers and cross-sectional, patient-reported assessments of healthcare provider counseling and treatment practices.
Pretraining, posttraining, and extended followup surveys were collected from providers. Perceived ability, confidence, and intention (ACI) to address smoking with patients were assessed with a composite ACI index. The mean age of physicians in the cohort was 44 years, 57% were male, and 69% were white. Mean number of years in practice was 15, mean number of patients seen per week was 103, mean time spent per patient visit was 16 minutes, and 85% had never used tobacco.
There were no baseline differences between participants assigned to the 2 groups. The mean age of pharmacists was 44 years, 47% were male, and 67% were white. Mean number of years in practice was 18, mean number of prescriptions filled per week by the pharmacy was 2104, and 82% had never used tobacco. Baseline characteristics were similar in the 2 study groups. The extended follow-up survey was completed by 95% of the physicians and 90% of the pharmacists. There were no baseline differences in the ACI index between the intervention and control groups for both pharmacists and physicians.
The percentage of physicians with a high ACI in the intervention group increased from 27% to 73% (P<.001) from pretraining to posttraining compared with the control group, where the increase was from 27% to 34% (P=.42). Among the pharmacists, the percentage in the intervention group with a high ACI increased from 4% to 60% (P<.001) from pretraining to posttraining, compared with those in the control group, where the percentage increased from 10% to 14% (P=.99). At baseline, fewer pharmacy patients reported being asked about smoking compared with patients seen by physicians (7% vs 33%; P=.001).
Among physicians in the intervention group, there was an increase in assisting patients in smoking cessation from baseline to 12-month follow-up (from 6% to 35%; P=.002); there were no increases in the control group. In summary, the researchers noted that “training led to significant and lasting improvement in counseling among physicians. Low levels of counseling were seen among pharmacists.”