Practice staff counseling aided smoking cessation. (In Primary Care Setting).

BETHESDA, MD. -- Smoking cessation rates rose "dramatically" in primary care practices where nurses and medical assistants used a brief counseling intervention with patients who smoked, Dr. David A. Katz reported at the annual meeting of the American Society of Preventive Oncology.

Research has shown that counseling by nonphysicians, counseling by two or more types of clinicians, and proactive telephone counseling all improve smoking cessation rates in the primary care setting, said Dr. Katz of the University of Wisconsin, Madison.

He and his associates assessed how a nurse-based intervention program incorporating these elements affected smoking cessation outcomes in family medicine and internal medicine clinic practices. Four other practices that followed their usual care patterns served as controls.

Subjects included adult patients who were smokers and presented to the practices for routine nonemergency care. There were 642 in the intervention group and 499 in the control group. "Our study sample was fairly representative of primary care patients seen in the Midwest," he noted.

The practice staff--mainly RNs and LPNs but also medical assistants and receptionists--were trained to do a smoking assessment and counseling intervention that took no more than 2-3 minutes. The first and most important step was to put a modified "vital signs" stamp on each patient chart so that whoever recorded the patient's vital signs at the office visit also recorded his or her smoking status.

A nurse or medical assistant would then determine how much the patient smoked, give a brief message in favor of quitting, and ask whether the patient was willing to try to quit within the next 6 months.

If the patient said no, he or she was given a patient education pamphlet on the benefits of quitting. Patients who said yes also received the educational materials, then were helped to set a quit date. They were given a voucher for free nicotine replacement therapy that could be redeemed at the clinic, provided with brief counseling in support of quitting, and given the business card of a trained smoking cessation counselor.