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Primary Care Provider Attitudes Predict Reported Smoking Cessation Behavior
Meredith LS, Yano EM, Hickey SC, Sherman SE. Primary Care Provider Attitudes Predict Reported Smoking Cessation Behavior. Paper presented at: Society of General Internal Medicine Annual Meeting; 2003 May 2; Vancouver, Canada.
Background Most primary care providers (PCPs) endorse the importance of smoking cessation but counseling rates are low. PCPs face numerous competing demands, particularly within the VA which treats a high proportion of older patients who suffer from multiple chronic diseases. It is therefore uncertain whether positive attitudes about helping patients quit smoking are associated with reported practices. We evaluated the consistency of attitudes and reported behavior regarding smoking cessation among a sample of PCPs in multiple VA settings. Methods Patients and PCPs from 20 VA sites in Southwestern and Western US participated in a smoking cessation quality improvement program that included PCP and patient education, local priority setting with leadership and providers, and local implementation. All eligible PCPs (N = 466) received 3 mailings followed by an e-mail and 61% (N = 281) returned a completed survey 12 months following intervention implementation. We used OLS regression analysis to identify predictors of reported smoking cessation behavior (frequency of personally counseling patients to quit smoking OR referring smokers to a VA Smoking Cessation program). Independent variables included an intervention condition, provider type, time since completing training, frequency of specialist consults, readiness to change, perceived skill in providing services to patients who smoke, perceived barriers to providing optimal smoking cessation care, and attitudes toward providing smoking cessation care. Results We observed no intervention effects. PCP smoking cessation attitudes was the strongest predictor of both reported smoking cessation counseling (p < .0001) and referral to a smoking cessation program (p < .01). Other predictors of counseling included the perceived barrier that 'patients are not interested in quitting' (p < .01) and a trend for PCPs with fewer years in practice to provide more counseling (p = .06). For referral behavior, other predictors were more specialty consultations (p < .001) and higher perceived skill (p = .02). The perceived barriers: 'preferred medications are difficult to obtain' (p = .06) was positively and 'referral not convenien' (p = .001) was negatively associated with referral behavior. Conclusion PCPs, regardless of participation in the smoking cessation intervention, had attitudes consistent with their reported smoking cessation behaviors. Additional analysis to determine if reported behavior is associated with actual quit rates and of patient and system barriers may explain low rates of smoking cessation counseling by PCPs.