Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care

Background. The Agency for Healthcare Research and Quality Smoking Cessation Practice Guideline recommends systematic assessment of smoking status and counseling of smokers at every visit, but the actual effectiveness of the guideline in primary care practice is unknown. Methods. We conducted a nonrandomized, controlled before-after trial of a guideline-derived intervention that includes routine identification and brief counseling of smokers by nurses and medical assistants, coupled with free nicotine replacement therapy (NRT) and telephone counseling of those smokers who are willing to make a quit attempt, and feedback on performance of guideline-recommended activities. The intervention was pilot tested at I family practice (FP) clinic over a 2-month period; patterns of usual care were observed concurrently at four control FP clinics. We obtained exit interviews of 651 consecutive adult smokers who presented for routine, nonemergency care. Abstinence (7-day point prevalence) was determined by telephone interview during 6-month follow-up. Results. Concordance with guidelines was significantly greater for all recommended actions at the test site during the intervention versus baseline (P less than or equal to 0.05). Significantly more intervention versus baseline patients at the test site reported abstinence at 2-month follow-up (21 vs. 4%, P = 0.0004), and more patients tended to be abstinent at 6-month follow-up (21 vs. 11%, P = 0.08). No significant differences in 2- or 6-month quit rates between intervention and baseline patients were observed at the control sites. Conclusions. Implementation of a guideline-driven smoking cessation intervention that focuses primarily on smokers who are interested in making a quit attempt is associated with increased abstinence in primary care practice. (C) 2002 American Health Foundation and Elsevier Science (USA).