Physicians lack smoking cessation training

Poor quit rates may reflect lack of provider knowledge

29 oct 2008--Physicians and other health-care providers may advise their patients to quit smoking, but few providers have the adequate training to follow their patients through the cessation process. New research presented at CHEST 2008, the 74th annual international scientific assembly of the American College of Chest Physicians (ACCP), shows that 87 percent of physicians and other medical professionals receive less than 5 hours of training on tobacco dependence and less than 6 percent knew Agency for Healthcare Research and Quality (AHRQ) treatment guidelines for tobacco dependence, including the signs of nicotine withdrawal. Researchers speculate that this lack of knowledge related to tobacco dependence treatment may, in turn, affect quit rates among smokers.
"If health-care providers are unaware of the AHRQ guidelines for tobacco dependence, and consequently unsure of how to treat their patients who are tobacco-dependent, they are less likely to do more than ask and advise their patients to quit," said the study's lead researcher, Virginia Reichert, NP, who conducted her research while at the North Shore-LIJ Health System Center for Tobacco Control, Great Neck, NY.
Researchers from the North Shore-LIJ Center for Tobacco Control surveyed 600 health-care providers, of which 322 were considered prescribers (physicians, nurse practitioners, or physician assistants), and the remaining 278 participants were considered nonprescribers (pharmacists, registered nurses, social workers, counselors, respiratory therapists, and students). Survey questions regarding tobacco control issues were related to prevalence of smoking, tobacco treatment guidelines, cessation pharmacotherapy, interaction of nicotine with other drugs, and symptoms and implications of nicotine withdrawal.
Results showed that a significant number of health-care providers lack general knowledge related to tobacco dependence treatment. Of those surveyed, 87 percent of prescribers and 93 percent of nonprescribers received less than 5 hours of tobacco-dependence training. In addition, only 6 percent of prescribers and 5 percent of nonprescribers knew the AHRQ treatment guidelines for tobacco dependence.
"Without appropriate training in tobacco dependence treatment, health-care providers may lack the knowledge and confidence to help their patients quit smoking," said Ms. Reichert. "Furthermore, providers may not recognize that tobacco dependence is a chronic relapsing condition and become frustrated when patients do not quit when advised to do so." Research indicates that approximately 70 percent of smokers report a desire to quit but believe it will be too difficult without assistance. Research also indicates that smokers are 30 percent more likely to quit with assistance from their health-care provider.
In relation to cessation pharmacotherapy, 16 percent of prescribers and 8 percent of nonprescribers knew which FDA-approved medications were over-the-counter and which required a prescription. The majority of prescribers and nonprescribers also failed to recognize select contraindications and changes to medication dosages in patients undergoing smoking cessation. In addition, only 1 percent of prescribers and 3 percent of nonprescribers correctly identified the signs of nicotine withdrawal.
"If clinicians are unaware of the contraindications related to cessation medications, this could lead to adverse reactions for the patient and, consequently, a failure to quit," said study author Patricia Folan, RN, acting director of the North Shore-LIJ's Center for Tobacco Control. "In addition, if clinicians are unaware of withdrawal symptoms, they may not encourage their patients to use the cessation medications. Without the cessation medications, patients experience the discomfort of withdrawal symptoms and are less likely to sustain their quit attempt."
"Patients who are advised to quit smoking, but who are not given the tools and resources to help them, will be less likely to quit," said James A. L. Mathers, Jr., MD, FCCP, President of the American College of Chest Physicians. "Health-care providers must be educated about the smoking cessation process and available resources in order to provide comprehensive guidance to patients who wish to stop smoking."
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CHEST 2008 is the 74th annual international scientific assembly of the American College of Chest Physicians, held October 25-30 in Philadelphia, PA. ACCP represents 17,000 members who provide patient care in the areas of pulmonary, critical care, and sleep medicine in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at www.chestnet.org.