Learning Objectives: : Identify smoking-related attitude and compliance differences between physicians, nurses and medical assistants and understand the implications for clinic-based smoking cessation efforts.
Abstract:
Problem/Objective: Clinic-based smoking cessation activities have not been widely implemented. We compared and contrasted primary health care professionals on 1) perceived barriers; 2) knowledge and perceptions of cessation efforts; and 3) smoking cessation responsibilities.
Methods: In summer 2002, we mailed cross-sectional, self-administered surveys to primary care physicians (MD), advanced practice nurses (ARN), registered nurses (RN), licensed practical nurses (LPN), and medical assistants (MA) practicing in Minnesota. Response rates: physicians 58% (1067/1832), nurses 75% (1723/2332), medical assistants 73% (330/443).
Results: 68% reported having a smoking cessation clinical guideline. Most document smoking status (79%); other system interventions lag around 30%. Few assess readiness to quit, counsel, assist or arrange follow-up. Lack of time and other priorities limit delivery of smoking cessation services as do believing patients resist cessation messages and counseling doesn’t affect behavior. Smoking cessation’s relative importance among nine preventive services declined from MD (1.9) to ARN (2.5), RN (3.4), LPN (4.2), MA (4.6). Believing smoking cessation services are very important to their clinic management declined (76%, 63%, 48%, 53%, 51% respectively) as did perceived patient receptivity to quitting (25%, 15%, 8%, 5%, 3% respectively). Prevalence of current smokers increased from 1% in MD to 3%, 9%, 17%, and 22% in MA.
Conclusions: Clinic-based smoking cessation efforts have relied heavily on supportive physicians. Other staff consider smoking cessation less important, believe patients are not amenable to cessation interventions and report limited participation in cessation activities. Education, system changes, and training must address attitudes, knowledge, and responsibilities of all team members.
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