摘要：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 [CI]=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% CI=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. Cigarette smoking is the leading cause of mortality in the United States. 1 , 2 Despite strong evidence that brief physician interventions at office visits increase patients’ smoking cessation rates, US physicians have had low rates of identifying patients’ smoking status and counseling about smoking. 3 – 6 Analysis of data from the 1991–1995 National Ambulatory Medical Care Surveys (NAMCSs) revealed that US physicians identified patients’ smoking status at 66% of outpatient visits and counseled about smoking at 22% of visits by smokers. 3 Since these data were collected, substantial efforts have been made to increase physicians’ activities regarding the treatment of tobacco dependence. The US Public Health Service released and promoted evidence-based national guidelines for the treatment of tobacco use in 1996 and updated them in 2000. 4 , 7 These guidelines recommend that at every office visit physicians identify a patient’s smoking status, advise every smoker to quit, and offer brief counseling and pharmacotherapy to all smokers who are ready to quit. In 1997, tobacco treatment became a quality-of-care measure for assessing the performance of physicians and health plans. 8 Since 1996, new smoking cessation medications (bupropion and new nicotine replacement products) have become available for physician prescription, and the nicotine gum and patch have switched to nonprescription status. 9 These factors expanded treatment options and increased national attention on physicians’ treatment of smokers. We hypothesized that US physicians’ rates of identifying smoking status, counseling about smoking, and prescribing cessation medications would have increased over the past decade. We used the NAMCS to compare US physicians’ practice patterns between 1994–1996 and 2001–2003.
