Asking About Smoking Status when Checking Vitals Increases Advice to Quit, but not Help with How, VCU Study Finds

By Anne Buckley

Routinely asking patients whether they smoke cigarettes as part of measuring blood pressure and other vital signs during a doctor's visit increases the chances that they will be advised to quit, but it doesn't result in more discussion on how, according to a Virginia Commonwealth University study published today.

However, even offering simple advice to quit could result in more patients kicking the habit, according to Stephen Rothemich, M.D., of the VCU School of Medicine's Department of Family Medicine. The study was published in the January/February 2008 issue of the Annals of Family Medicine.

Current guidelines encourage primary care physicians to document a patient's smoking status when obtaining a patient's blood pressure, temperature and pulse. But it was previously unclear how much this information alone could influence the frequency and intensity with which patients received smoking cessation counseling, he said.

The study examined 6,729 adult patients, 1,149 of whom were smokers, at 18 primary care practices during a six-month period. One group, the intervention practices, systematically assessed smoking status when vital signs were measured. The other group, control practices, used no systematic screening for smoking. The study measured the proportion of smokers who reported clinician counseling of any kind and the frequency of two subcomponents: simple advice to quit and more intensive discussion.

Results showed that 61.9 percent of the smokers at the intervention practices reported receiving any counseling, compared with 53.4 percent of the smokers at control practices. The advice given was largely simple advice that the patient should quit, Rothemich said. The study's authors estimate that by adopting the vital sign intervention, a practice of four clinicians could expect to gain an additional ex-smoker every six weeks.

The estimate is based on a previous meta-analysis that concluded that one of 40 patients who receive simple advice will quit.

Rothemich said there was no significant increase in more extensive discussion on quitting, such as useful tips and techniques, coping with setbacks, motivations and barriers.

"The good news is that including a patient's smoking status in the vital-sign gathering process does indeed increase advice to quit, which will help additional smokers stop", Rothemich said.  "However, many more could quit if practices were able to more frequently overcome the barriers to providing intensive assistance.

"Our findings add weight to arguments that increasing the delivery of this more effective counseling requires redesigning medical practices and health systems, including strategies like linking practices with telephone quit lines," he said.

The study was conducted within practices that participate in the Virginia Ambulatory Care Outcomes Research Network, or ACORN. ACORN is VCU's practice-based research network that engages primary care medical practices throughout Virginia in research that can have a relatively immediate impact on how health care is delivered. The study was funded by the Robert Wood Johnson Foundation.

###

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, we work with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For 35 years we've brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those we serve. When it comes to helping Americans lead healthier lives and get the care they need, we expect to make a difference in your lifetime.  For more information visit www.rwjf.org.