The effect of systematic clinical interventions with cigarette smokers on quit status and the rates of smoking-related primary care office visits
UMass Chan Affiliations
Department of Medicine, Division of Preventive and Behavioral MedicineDocument Type
Journal ArticlePublication Date
2012-07-24Keywords
DemographyFemale
Humans
Intervention Studies
Likelihood Functions
Male
Massachusetts
Middle Aged
Models, Statistical
Office Visits
Prevalence
Primary Health Care
Smoking
Smoking Cessation
Behavioral Disciplines and Activities
Behavior and Behavior Mechanisms
Clinical Epidemiology
Community Health and Preventive Medicine
Epidemiology
Preventive Medicine
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Show full item recordAbstract
BACKGROUND: The United States Public Health Service (USPHS) Guideline for Treating Tobacco Use and Dependence includes ten key recommendations regarding the identification and the treatment of tobacco users seen in all health care settings. To our knowledge, the impact of system-wide brief interventions with cigarette smokers on smoking prevalence and health care utilization has not been examined using patient population-based data. METHODS AND FINDINGS: Data on clinical interventions with cigarette smokers were examined for primary care office visits of 104,639 patients at 17 Harvard Vanguard Medical Associates (HVMA) sites. An operational definition of "systems change" was developed. It included thresholds for intervention frequency and sustainability. Twelve sites met the criteria. Five did not. Decreases in self-reported smoking prevalence were 40% greater at sites that achieved systems change (13.6% vs. 9.7%, p<.01). On average, the likelihood of quitting increased by 2.6% (p<0.05, 95% CI: 0.1%-4.6%) per occurrence of brief intervention. For patients with a recent history of current smoking whose home site experienced systems change, the likelihood of an office visit for smoking-related diagnoses decreased by 4.3% on an annualized basis after systems change occurred (p<0.05, 95% CI: 0.5%-8.1%). There was no change in the likelihood of an office visit for smoking-related diagnoses following systems change among non-smokers. CONCLUSIONS: The clinical practice data from HVMA suggest that a systems approach can lead to significant reductions in smoking prevalence and the rate of office visits for smoking-related diseases. Most comprehensive tobacco intervention strategies focus on the provider or the tobacco user, but these results argue that health systems should be included as an integral component of a comprehensive tobacco intervention strategy. The HVMA results also give us an indication of the potential health impacts when meaningful use core tobacco measures are widely adopted.Source
Land TG, Rigotti NA, Levy DE, Schilling T, Warner D, et al. (2012) The Effect of Systematic Clinical Interventions with Cigarette Smokers on Quit Status and the Rates of Smoking-Related Primary Care Office Visits. PLoS ONE 7(7): e41649. doi:10.1371/journal.pone.0041649. Link to article on publisher's siteDOI
10.1371/journal.pone.0041649Permanent Link to this Item
http://hdl.handle.net/20.500.14038/44860PubMed ID
22911834Related Resources
Link to Article in PubMedRights
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0041649