July 2000

Grant Results

SUMMARY

In 1996, the American Medical Association (AMA), Chicago, produced and disseminated a pocket guide, Helping Smokers Quit: A Guide for Primary Care Clinicians, prepared by the federal Agency for Health Care Policy and Research (AHPCR) as a summary of its Clinical Practice Guideline on Smoking Cessation.

The guide summarizes AHCPR's Guideline on Smoking Cessation and reminds primary care practitioners to ask for and record the tobacco-use status of every patient.

Key Results

  • The AMA mailed the pocket guide to 200,000 primary care physicians in early summer 1996, accompanied by a cover letter promoting its use with patients and offering resources for further information. Just prior to the mailing, the AMA publicized distribution of the pocket guide to increase interest within the medical community.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $70,893 between May and July 1996.

 See Grant Detail & Contact Information
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THE PROBLEM

Tobacco use has an enormous impact on health in the United States. Twenty-five percent of adult Americans smoke cigarettes, yet smokers enter and exit the health care system each day without receiving treatment for this important health risk. Clinicians have unique access to individuals who use tobacco because more than 70 percent of smoking Americans visit a clinician each year, according to a 1995 report from the US Agency for Health Care Policy and Research (AHCPR). Yet half of these individuals report that a clinician has never urged them to quit, and more than 70 percent now say they want to quit and have made at least one unsuccessful prior quit attempt.

The Clinical Practice Guideline on Smoking Cessation, developed by an expert panel convened by AHCPR, offers a simple and flexible set of strategies designed to ensure that all patients who use tobacco are offered motivational interventions and effective treatments by health care providers to overcome this powerful addiction. In conjunction with release of the guideline in April 1996, RWJF initiated a strategy to disseminate a concise version to organizations whose members have frequent contact with patients in primary care settings. The strategy was announced at a one-day media briefing on the hazards of tobacco held April 23, 1996, in Washington, D.C. The briefing, sponsored by the AMA and funded by RWJF (ID# 028586), featured presentations by nationally recognized health experts, including Michael Fiore, M.D., director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School, who chaired the expert panel that developed AHCPR's guideline. The presentations were based on papers subsequently published in the Journal of the American Medical Association (JAMA, April 24, 1996).

The AMA was a primary reviewer of the AHCPR guideline and endorsed it formally for use by its membership. RWJF considered the AMA's constituency of primary care physicians an important target group for information about smoking cessation treatment because of their daily contact with patients who smoke. The project continues RWJF's efforts to develop more effective methods to treat nicotine addiction and to create more effective strategies to prevent tobacco use among young people.

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THE PROJECT

This grant from RWJF supported the production and dissemination of a pocket guide, Helping Smokers Quit: A Guide for Primary Care Clinicians, prepared by AHCPR as a summary of its Clinical Practice Guideline on Smoking Cessation. Foundation funds covered production and printing costs, labels, envelopes, and postage.

The pocket guide emphasizes these points:

  • Every person who smokes should be offered smoking cessation treatment at every office visit.
  • Clinicians should ask about and record the tobacco-use status of every patient.
  • Cessation treatments even as brief as three minutes a visit are effective.
  • The more intense the treatment, the more effective it is in producing long-term abstinence from tobacco.
  • Nicotine replacement therapy (nicotine patches or gum), behavioral counseling, social support, and skills training are effective components of smoking cessation treatment.
  • Health care systems should be modified to routinely identify and intervene with all tobacco users at every visit.

The pocket guide also reminds primary care clinicians to ask for and record the tobacco-use status of every patient. Contact information for obtaining the full AHCPR guideline is included.

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RESULTS

  • Using a template provided by AHCPR, the AMA printed the pocket guide, adding its own logo to the publication.
  • The AMA mailed the pocket guide to 200,000 primary care physicians in early summer 1996, accompanied by a cover letter promoting its use with patients and offering resources for further information. Just prior to the mailing, the AMA publicized distribution of the pocket guide to increase interest within the medical community.

There was no evaluation of physicans' use of the guide.

Communications

The AMA's plans to distribute the pocket guide were publicized in the AMA's in-house publication, American Medical News, and through press releases and satellite feeds to radio and television outlets. (See the Bibliography for details.) These publicity efforts complemented AHCPR's efforts to publicize its guideline. The AMA's mass mailing was directly linked to a national conference on policy issues related to implementation of AHCPR's Clinical Practice Guideline on Smoking Cessation, which was held September 17–18, 1996, in Washington, D.C., and funded in part by RWJF (ID# 027474).

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LESSONS LEARNED

  1. The usefulness of broad-based practice guidelines should be evaluated. If the goal is to influence the adoption of best treatment practices, then the value of guidelines that cut across different physician specialties and multiple disciplines — such as medicine and nursing — should be determined.

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AFTER THE GRANT

After the AMA's dissemination of the pocket guide, a number of other health care organizations whose members have regular access to patients who smoke were awarded RWJF grants to disseminate the guide: the American Academy of Pediatrics (ID# 030329), the American College of Obstetricians and Gynecologists (ID# 030520), the American Medical Women's Association, Inc. (ID# 030375), the American Nurses Association (administered through the American Nurses Foundation, Inc., ID# 030254), and the American College of Chest Physicians (administered through Creighton University, ID# 030525). Grant ID# 029389 funded the Medical College of Wisconsin to develop a dissemination strategy and to oversee these projects. See the Grant Results on these projects. RWJF also funded dissemination to organized labor. See the Grant Results on ID# 029471.

A revised version of the AHCPR guideline was published in 2000.

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GRANT DETAILS & CONTACT INFORMATION

Project

Primary Care Practitioners' Pocket Guide on the AHCPR Smoking Cessation Guideline

Grantee

American Medical Association (Chicago,  IL)

  • Amount: $ 70,893
    Dates: May 1996 to July 1996
    ID#:  029466

Contact

Thomas P. Houston, M.D.
(312) 464-6359
thomas_houston@ama-assn.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Brochures and Fact Sheets

"Helping Smokers Quit: A Guide for Primary Care Clinicians." The Agency for Health Care Policy and Research, April 1996.

"Clinical Practice Guideline: Treating Tobacco Use and Dependence." U.S. Department of Health ad Human Services, Public Health Service, June 2000.

Press Kits and News Releases

A 90-second Journal of the American Medical Association video news release on the smoking cessation pocket guide was fed to television outlets around the United States on May 28, 1996. Forty-eight television stations, reaching an estimated audience of more than nine million people, used the feed on their broadcasts.

A one-minute radio report on smoking cessation guidelines was fed to radio outlets around the country on May 28, 1996.

A news release on the AMA's mailing of the AHCPR pocket guide to 200,000 physicians was sent to newspapers around the United States on May 29, 1996.

"Helping Smokers Quit: A Guide for Primary Care Clinicians" was mailed with a cover letter from the AMA to 200,000 physicians in early June 1996.

Print Coverage

"How to Quit," in American Medical News, May 20, 1996.

"Doctors Enlisted in Anti-Smoking Crusade," in New York Post, May 29, 1996.

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Report prepared by: Kelsey Menehan
Reviewed by: Karyn L. Feiden
Reviewed by: Marian Bass
Program Officer: Joseph F. Marx