• Lisa S Meredith, Elizabeth M Yano, Scot C Hickey, and Scott E Sherman.
• RAND Corporation, Santa Monica, California 90407-2138, USA. lisa_meredith@rand.org
• Med Care. 2005 Sep 1;43(9):929-34.

ObjectiveMost primary care providers (PCPs) endorse the importance of smoking cessation, but counseling rates are low. We evaluated the consistency of PCP's attitudes toward smoking cessation counseling and corresponding smoking-cessation behaviors.DesignThis was a postintervention analysis of a population-based sample from a group randomized controlled trial to improve adherence to smoking cessation guidelines.SettingA total of 18 VA sites in Southwestern and Western United States participated.ParticipantsA total of 280 PCPs completed a survey at 12 months after the implementation of a smoking-cessation quality improvement (QI) program. Their patients also completed 12- (n = 1080) and 18-month (n = 924) follow-up surveys.InterventionThe quality improvement intervention included local priority setting, quality improvement plan development, implementation, and monitoring.Measurements And Main ResultsPCPs at intervention sites were more likely to report counseling patients about smoking cessation (P = 0.04) but not referral. PCP attitude toward smoking-cessation counseling was strongly associated with reported counseling (P < 0.001) and with referral (P = 0.01). Other associations with counseling were the perceived barrier "patients are not interested in quitting" (P = 0.01) and fewer years in practice (P = 0.03); other associations with referral were specialty consultation (P < 0.0001) and the perceived barrier "referral not convenient" (P = 0.001) (negative association). PCP attitudes were associated with higher rates of counseling, referral, and program attendance.ConclusionsPCPs, regardless of intervention participation, had attitudes consistent with their reported smoking-cessation behaviors and more favorable attitudes were associated with higher rates of patient-reported smoking cessation behavior. Findings suggest that PCPs who endorse smoking-cessation counseling and referral may provide more treatment recommendations and have higher patient quit rates.

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