Use of Office-Based Smoking Cessation Activities in Family Practices

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Original Research

Use of Office-Based Smoking Cessation Activities in Family Practices

J Fam Pract. 2000 November;49(11):1025-1029

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There are a number of strengths that make our study unique. The most important of these is that our results are based on direct observation of activities in 89 practices, almost half of all the family practices in Nebraska. It is very likely that our results reflect actual typical practice in our area. Additionally, our use of a multimethod approach enhances the validity of the results by triangulating data (eg, comparing our key informant information about documentation with audits of the medical record).

Limitations

There are some factors that affect the generalizability of our results. Our sample was composed of Nebraska family practices and may not represent other states that differ in smoking rates, taxes on tobacco, or other factors affecting smoking rates. Our assessment of practices focused primarily on the occurrence of office-based activities, so our office-based activity score does not reflect the activities of the individual target physician in the practice. It is possible that a practice could have a low score and a very proactive physician. However, since office-based activities are designed to support the physician’s message, not eliminate it, this practice would still be missing opportunities to reinforce and support the physician’s ability to provide effective cessation messages. Finally, although the NCI monograph and the AHCPR practice guideline outline the suggested best practice for office-based activities, it may not be one that all physicians embrace. Some may consciously choose to limit these activities in their practice.

Conclusions

The NCI monograph suggests that practices are like patients in their stage of readiness¹⁸ to implement office-based strategies. We speculate that movement of a practice out of the first basic level (where the majority of our practices fell) would require acceptance of the use of office-based systems as the standard of care. Examples would include seeing and hearing their peers use office-based activities effectively, being reimbursed for having these activities in place, training residents in a system that uses office-based activities, and providing help to practices interested in implementing and maintaining activities suited to their needs. Our efforts must now focus on helping practices implement the knowledge we have gained.

Acknowledgments

Our study was supported by a grant from the Nebraska Department of Health and Human Services, Cancer and Smoking Disease Program (96-05B). We wish to express our thanks to Connie Gibb, RN, for her invaluable assistance in data collection, Naomi Lacy, PhD, for her editing, and all of the family physicians in Nebraska who were willing to open their practices to us.