Adherence to smoking cessation guidelines (5As) by psychiatrists and primary care physicians for persons with serious mental illness

Abstract

Smoking rates are three times higher among people with serious mental illness (PWSMI), yet, earlier studies showed that physician compliance with smoking cessation guidelines (5As) for PWSMI is low.

Objectives:

1) Compare the 5A (Ask-Advise-Assess-Assist-Arrange) practice rates between psychiatrists and primary care physicians (PCPs) regarding smoking cessation for PWSMI. 2) Compare the 5A practice rates reported by physicians with rates reported by PWSMI. 3) Identify which specialty is perceived as primarily responsible for smoking cessation promotion for PWSMI.

Methods:

Telephone surveys were carried out in a large health maintenance organization (HMO) among all psychiatrists, a random sample of PCPs, and HMO members with serious mental illness who had registered/participated in a smoking cessation program. Physicians were asked how frequently they carried out each 5A practice, along with questions regarding role responsibility and interaction between the two clinical specialties. PWSMI were asked to report about each 5A practice by both PCP and treating psychiatrist.

Results:

Ask-Advise-Assess rates were higher than Assist-Arrange rates for both specialties. 83% of PCPs had satisfactory 5A practice scores compared to 46% of psychiatrists (X²=23.9, p < 0.001). With the exception of Ask rates, physician rates for each 5A component were higher than those reported by PWSMI. PCPs were more likely to see smoking cessation promotion as their responsibility and did not always confer with the psychiatrist regarding referral and SCM prescription.

Conclusions:

Interventions focusing on promoting Assist-Arrange practices and better integration between the specialties are required.

Keywords:

• 5A guidelines
• physician practices
• smoking cessation
• serious mental illness

Acknowledgements

Many thanks to all the physicians that gave of their time to be interviewed.

Declaration of interest

No conflict of interest to report. The study was carried out in a large health maintenance organization (HMO) with the support of the HMOs research fund (see above). Two of the authors were employees of the HMO at the time of the study. Beyond initial approval of the study, both the HMO and its research fund had no input into the data gathering process, analysis or the writing of the article presented here.