Adoption of Policies to Treat Tobacco Dependence in US Medical Groups

Most larger U.S. medical practices have some strategy in place to treat patients’ tobacco dependence. But few have instituted a multi-strategy effort as recommended by Public Health Service (PHS) Clinical Practice Guideline for Treating Tobacco Use and Dependence, according to this survey-based study.

Tobacco use is the largest cause of disease and premature death in the United States. Since 1996, PHS has issued evidence-based guidelines suggesting system-level strategies to treat tobacco dependence. This study looked at the extent to which larger U.S. medical practices have adopted one or more of these strategies; it also sought to identify characteristics of the practices with broader implementation. Survey data was collected in 2006-2007 from 339 medical groups with 20 or more doctors treating four or more chronic conditions.

Key Findings:

  • Nearly 83 percent of these practices had instituted at least one PHS-recommended strategy.
  • Only 5.6 percent had implemented all eight tobacco-control activities studied.
  • Six characteristics of practices were associated with broader implementation: (1) being owned by a hospital, hospital system or HMO; (2) being more patient-centered; (3) being profitable in the past year; (4) having better clinical IT capabilities; (5) being externally evaluated on patient satisfaction or clinical quality; and (6) participating in any kind of quality demonstration program.
  • The 7.7 percent of practice groups that received financial incentives from HMOs to promote anti-smoking programs were nearly three times more likely to evaluate the related efforts of their doctors.
  • Most practices document patient tobacco use (73.2%); require doctors to advise patients to quit (71.4%); and require doctors to provide anti-smoking information (69.3%). By contrast, few (27.1%) can identify tobacco-using patients within their data systems in order to provide information.

Medical groups need to broaden their anti-smoking efforts. Analysis suggests there are many health care actors who can influence this adoption.