Smoking cessation in primary care: a clinical effectiveness trial of two simple interventions

Prev Med. 2004 Mar;38(3):284-94. doi: 10.1016/j.ypmed.2003.09.045.


Background: Many primary care practices do not have systematic protocols to identify patients who smoke or to encourage clinicians to provide smoking cessation advice. We designed a study to assess the relative effectiveness of two brief interventions on screening for smoking, physician cessation advice and patient smoking cessation rates.

Methods: We performed a nonrandomized comparison of alternative strategies for smoking cessation at a hospital-based adult primary care practice. Each intervention was implemented on a separate practice team. The "minimal" intervention consisted of a smoking status "vital sign" stamp which documented patient smoking status. The "enhanced" intervention consisted of a five-question form that assessed patient level of cessation readiness and provided cessation-counseling prompts for clinicians. Medical record documentation of screening for smoking and cessation advice and self-reported patient smoking cessation rates were collected 8-10 months after implementation.

Results: Smoking status was documented at 86%, 91%, and 49%, and cessation advice at 38%, 47%, and 30% of visits on the minimal, enhanced, and control teams, respectively (P < 0.001 for smoking status and P = 0.014 for advice). Self-reported patient smoking cessation was higher on the enhanced team (12%) compared with the minimal (2%) and control (4%) teams (P < 0.001).

Conclusions: A short questionnaire that assesses readiness-to-quit and provides documentation of cessation advice improves rates of clinician cessation advice and patient smoking cessation compared with no intervention.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Counseling*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care / methods*
  • Smoking Cessation / methods*
  • Smoking Cessation / psychology
  • Surveys and Questionnaires
  • Treatment Outcome