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Nurse-Assisted Counseling for Smokers in Primary Care

Jack F. Hollis, PhD; Edward Lichtenstein, PhDD; Thomas M. Vogt, MD, MPH; Victor J. Stevens, PhD; and Anthony Biglan, PhD
[+] Article, Author, and Disclosure Information

From Kaiser Permanente Center for Health Research, Portland, Oregon, and the Oregon Research Institute, Eugene, Oregon. Requests for Reprints: Jack F. Hollis, PhD, Center for Health Research, 3800 N. Kaiser Center Drive, Portland, OR 97227. Acknowledgments: The authors thank the medical staff and administrators of Kaiser Permanente, especially Drs. Richard Olson and John Bakke. They also thank John Noell, PhD, and Independent Video Services for producing the videos; Kathy Mount, Walter Crandall, Jae Douglas, and Steve Smith for intervention activities; Pierre LaChance, Maggie Vogt, and Kathy Pearson for analytic work; and Gary Miranda for editorial contributions. Grant Support: By Public Health Service Grant 1PO1-CA44648 from the National Cancer Institute.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(7):521-525. doi:10.7326/0003-4819-118-7-199304010-00006
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Objective: Physician-delivered advice to stop smoking is effective, but time demands often reduce the number of smokers who receive assistance. We evaluated three nurse-assisted interventions designed to minimize physician burden and increase counseling in primary care settings.

Design: Randomized controlled trial with a 12-month follow-up.

Setting: Internal medicine and family practice offices in a health maintenance organization.

Participants: Smokers (n = 3161) who were patients of participating physicians or other medical care providers (n = 60).

Intervention: Medical care providers delivered a 30-second stop-smoking prompt to 2707 smokers and referred them to an on-site nurse smoking counselor. The nurse randomly provided a two-page pamphlet [advice control] or one of three nurse-assisted interventions: 1) self-quit training; 2) referral to a group cessation program; or 3) a combination of self-quit training and referral. Each nurse-delivered intervention included a 10-minute video, written materials, and a follow-up phone call.

Results: Physicians delivered brief advice to 86% of identified smokers during the 1-year program. The proportion of participants reporting abstinence after both 3 and 12 months of follow-up nearly doubled (P = 0.01) for the nurse-assisted self-quit (7.1%), group-referral (7.6%), and combination (6.9%) interventions, compared to brief physician advice alone (3.9%) (P < 0.05). Saliva cotinine tests confirmed these effects (P < 0.004), although quit rates were lower (3.4%, 4.7%, 4.3%, and 2.3%, respectively) because roughly one half of quitters chose not to provide a saliva sample and were counted as smokers.

Conclusion: Involving nurses in counseling smokers reduces physician burden, makes counseling more likely, and significantly increases cessation rates compared with brief physician advice alone.





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