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Encouraging Primary Care Physicians To Help Smokers Quit: A Randomized, Controlled Trial

Stuart J. Cohen, EdD; George K. Stookey, PhD; Barry P. Katz, PhD; Catherine A. Drook, BS; and David M. Smith, MD
[+] Article, Author, and Disclosure Information

Grant Support: Supported by grant PHS 1 RO1 CA38337 from the National Cancer Institute.

Requests for Reprints: Stuart J. Cohen, EdD, Regenstrief Institute for Health Care, Fifth Floor, 1001 W. 10th Street, Indianapolis, IN 46202.

Current Author Addresses: Drs. Cohen, Katz, and Smith: Regenstrief Institute, Fifth Floor, Indianapolis, IN 46202.

Dr. Stookey and Ms. Drook: Oral Health Research, Indianapolis, IN 46202.

Ann Intern Med. 1989;110(8):648-652. doi:10.7326/0003-4819-110-8-648
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Study Objective: To increase the effect that primary care physicians have on their patients who smoke.

Design: Randomized, controlled trial with 112 general internists and their patients who smoke.

Patients: Sample of 1420 patients from a general medicine clinic of a city-county teaching hospital, who smoke at least one cigarette a day and were recruited regardless of their interest in quitting smoking.

Interventions: Physicians were randomly assigned to one of four groups: participants who received a protocol for smoking management and a lecture on the consequences and management of smoking (control); in addition, had nicotine gum freely available to patients (gum); had stickers attached to their smokers' charts (reminder); or had both gum and reminders (both).

Measurements and Main Results: The percentage of patients with a return visit at 6 months who quit smoking (alveolar carbon monoxide of less than nine parts per million) was 1. 3% (control), 7.7% (gum), 7.0% (reminders), and 6.3% (both). At 1 year the percentages were 2.7%, 8.8%, 15.0%, and 9.6%, respectively. Subsequent pairwise comparisons showed that the three intervention groups were not significantly different, but that each was significantly different from the control group (P < 0.05). Physicians in all three intervention groups spent significantly more time than did the physicians in the control group counseling their patients about smoking.

Conclusions: The availability of nicotine gum or labeling the charts of smokers can help primary care physicians increase their success rates two- to six-fold in helping patients quit smoking. If all primary care physicians used these procedures, they could help an additional 2 million smokers quit.





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