The treatment of smoking by US physicians during ambulatory visits: 1994-2003

Objectives. We sought to determine whether US physicians' practice patterns in treating tobacco use at ambulatory visits improved over the past decade with the appearance of national clinical practice guidelines, new smoking cessation medications, and public reporting of physician performance in counseling smokers. Methods. We compared data from the National Ambulatory Medical Care Survey, an annual survey of a random sample of office visits to US physicians, between 1994-1996 and 2001-2003. Results. Physicians identified patients' smoking status at 68% of visits in 2001-2003 versus 65% in 1994-1996 (adjusted odds ratio [AOR] = 1.16; 95% confidence interval [Cl]= 1.04, 1.30). Physicians counseled about smoking at 20% of smokers visits in 2001-2003 versus 22% in 1994-1996 (AOR=0.84; 95% Cl =0.71, 0.99). In both time periods, smoking cessation medication use was low (< 2% of smokers' visits) and visits with counseling for smoking were longer than those without such counseling (P <.005). Conclusions. In the past decade, there has been a small increase in physicians' rates of patients' smoking status identification and a small decrease in rates of counseling smokers. This lack of progress may reflect barriers in the US health care environment, including limited physician time to provide counseling.