Learning Objectives: At the conclusion of this presentation, attendees will understand the strategies that increase the likelihood that physicians will provide ongiong management to treat tobacco use as a chronic medical condition.
Abstract: Objective: To understand how physician attitudes, training, and clinic support are related to adoption of the 5A's by primary care physicians.
Methods: In the fall of 2000, a mail survey was performed of 1,474 primary care physicians practicing at 151 clinics in Minnesota. The response rate was 62% (901/1,474). The survey assessed physician demographics, clinic support for tobacco use interventions, attitude towards treatment of tobacco use, and self-reported practice patterns (5A's). Variables describing the clinic environment were derived from health plan administrative records. Analysis was preformed using mixed linear and logistic regression models to account for clustering of physicians within clinics.
Principal Findings: 37% of physicians reported only episodic treatment of tobacco use (no follow-up activities). 21% reported only limited treatment (not Asking, Advising, and Assessing). Only a small minority (11%) reported providing ongoing management (all 5A's). Controlling for physician and clinic demographics, we found positive physician attitudes toward tobacco use treatment increased likelihood of most intervention activities, except provision of follow-up contacts (i.e. not Arrange). Supportiveness of clinic environment increased likelihood of most treatment activities, except intervention or follow-up with tobacco users not making quit attempts (i.e. no motivational interventions provided). Training in tobacco use treatment increased likelihood of the complete range of treatment activities.
Conclusions: Clinic support, physician attitudes, and training are related to different steps in the adoption of the 5A's. These findings support the need for multi-faceted approaches targeting each of these factors to promote more complete treatment of tobacco use as a chronic medical condition.
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