Multiple Health Professionals
Lawrence C. An, MD, Steven S. Foldes, PhD, Nina L. Alesci, PhD, James H. Bluhm, MPH, Patricia C. Bland, MA, Michael E. Davern, PhD, Barbara A. Schillo, PhD, Jasjit S. Ahluwalia, MD, MPH, Marc W. Manley, MD, MPH Background: Smokers have contact with many different types of health professionals. The impact of tobacco intervention by multiple types of heath professionals is not known. Methods and As part of the 2003 Minnesota Adult Tobacco Survey, smokers (n 1723) reported on tobacco Materials:
treatment by medical doctors, nurses, dentists, pharmacists, or other health professionals. This analysis examined: (1) smokers’ report of tobacco intervention by different types of healthcare providers, (2) the proportion of smokers who report intervention by multiple provider types, and (3) the relationship between smokers’ report of intervention by multiple provider types and readiness to quit, quit attempts, and recent quitting.
Among past-year smokers, 65% had visits with two or more types of health professionals. Among smokers who visited health professionals (n 1523), only 34% reported being asked about smoking by two or more types of professionals. Among current smokers (n 1324), advice or assistance from more than one type of professional was uncommon (26% and 7%, respectively). Being asked about smoking by two or more types of professionals substantially increased the odds of recent quitting (OR 2.37; 95% CI 1.15– 4.88). Among current smokers, being advised to quit by two or more types of professionals increased the odds of having made a quit attempt in the past year (OR 2.92; 95% CI 1.56 –5.45) or intending to quit in the next 6 months (OR 2.17; 95% CI 1.10 – 4.29).
Conclusions: Smoking-cessation interventions by more than one type of health professional have the potential to substantially increase quitting and readiness to quit in the population. (Am J Prev Med 2008;34(1):54 – 60) © 2008 American Journal of Preventive Medicine
ost smokers have contact with many different
parts of the healthcare system, including hospitals,1–3 medical clinics,4 – 6 dental ofﬁces,6,7 and pharmacies.8,9 Smoking-cessation treatments are
effective when provided by physicians as well as nonphysician clinicians (e.g., nurses, dentists, pharmacists)10 –15 with a trend toward greater efﬁcacy for interventions that involve two or more types of health
professionals (e.g., doctor and nurse versus doctor
only).10 –16 At present, there is little information regarding how often smokers discuss cigarette use or receive advice to quit or assistance in quitting from more than
one type of health professional. Prior studies have
reported suboptimal rates of intervention by different
types of professionals (e.g., physicians,6,17 nurses,18
From the Division of General Internal Medicine (An, Ahluwalia), Division of Health Policy and Management (Davern), University of Minnesota; Clearway Minnesota (Schillo), Minneapolis; and Center for Prevention, Blue Cross and Blue Shield of Minnesota (Foldes, Alesci, Bluhm, Bland, Manley), Eagan, Minnesota
Address correspondence and reprint requests to: Lawrence C. An, MD, Assistant Professor of Internal Medicine, University of Minnesota, Mayo Building, Mail Code 741, 420 Delaware Street SE, Minneapolis MN 55455. E-mail: Lcan@umn.edu.
dentists,6,7,19 –21 and pharmacists9,22). However, it is
unclear how these practice patterns inﬂuence the experience of an individual smoker who may visit many different types of health professionals over time. It is
also unclear how cessation interventions by more than
one type of health professional in actual practice might
inﬂuence an individual’s cigarette use.
The 2003 Minnesota Adult Tobacco Survey (MATS),
a population-based survey of adults in Minnesota, provides an opportunity to address these unanswered questions. The MATS collected information...