Clinical practice guidelines recommend that clinicians implement the 5As (Ask, Advise,

Clinical practice guidelines recommend that clinicians implement the 5As (Ask, Advise, Assess, Assist, and Arrange) for smoking cessation at every clinical encounter. 95% CI 0.3C0.8) or assessed for readiness to quit (AOR 0.6, 95% CI 0.4C0.9), patients with pulmonary diseases had higher odds of reporting being assisted (AOR 1.6, 95% 1.0C2.6) than patients without these diagnoses. Although the majority of clinicians reported asking (91.8%), advising (91.8%), and assessing (93.4%) tobacco use most of the time or always during a clinical encounter, fewer reported assisting (65.7%) or arranging (19.7%) follow-up. Only half of patients reported being screened for tobacco use and fewer reported receipt of the other 5As, with significant disparities in receipt of the 5As among patients with HIV. Our findings confirm the need for interventions to increase clinician-delivered cessation treatment in primary and HIV care. Keywords: Smoking cessation, AZ 3146 5As for smoking cessation, Primary care 1.?Introduction Tobacco use is the leading preventable cause of death, and is responsible for >?480,000 deaths annually in the United States (U.S.) (U.S. Department of Health and Human Services, 2014). The major causes of excess mortality among smokers stem from smoking-related cancers, cardiovascular disease and respiratory disease (Centers for Disease Control and Prevention, 2008a, Jha et al., 2013). Although the past 4 decades have seen significant declines in the prevalence of smoking in the general population, prevalence remains high among certain populations (Prevention CfDCa, 2014, Jamal et al., 2015). Low-income persons (Prevention CfDCa, 2014, Jamal et al., 2015), racial/ethnic minorities (Jamal et al., 2015, Centers for Disease Control and Prevention, 2005), persons with mental health disorders or substance use disorders (Schroeder and Morris, 2010), indigent persons living with HIV/AIDS (Vijayaraghavan et al., 2014), and persons who are uninsured or publicly insured (Centers for Disease Control and Prevention, n.d.), bear a disproportionate burden of tobacco-related morbidity and mortality (Centers for Disease Control and Prevention, 2008b). Primary care clinicians are in a unique position to help patients quit smoking by employing strategies outlined in the U.S. Public Health Service guidelines (Fiore et al., 2008). These guidelines recommend that all clinicians offer brief interventions for smoking cessation at all or nearly all encounters using the 5As (Ask about smoking, Advise cessation, Assess readiness to quit, Assist with motivation and/or cessation, and Arrange follow-up) (Fiore et al., 2008) Most smokers in the general population are interested in quitting smoking and almost half attempt to quit smoking yearly (Centers for Disease Control and Prevention, 2011). Smokers are receptive to counseling for smoking cessation (Fiore et al., 2008), and about half report having received advice to quit from a health professional (Centers for Disease Control and Prevention, 2011, Kruger et al., 2012). Most smokers cite clinician’s advice to quit smoking as an important motivator for smoking cessation (Kruger et al., 2012, Gilpin et al., 1993). Receipt of clinician-delivered counseling, in particular the more intensive Assist and Arrange interventions for smoking cessation has been shown to AZ 3146 increase cessation (Fiore et AZ 3146 al., 2008, Park et al., 2015). Receipt of all the 5As compared to one or none during a clinical encounter has been associated with increased use of cessation services (Kruger AZ 3146 et al., 2016). Despite patients’ interest in receiving counseling, there is significant variability in clinician delivery of the 5As (Park et al., 2015, Ferketich et al., 2006, Thorndike et al., 2007). Previous research has shown that while most smokers are screened for tobacco use, fewer are advised to quit or assessed for their readiness to quit, and only a minority report receipt of clinician-delivered Assist (pharmacotherapy and/or more intensive counseling) or Arrange (Park et al., 2015, Ferketich et al., 2006, Jamal et al., 2012). Fewer than 25% of Medicaid-enrolled smokers reported receiving assistance with cessation (Chase et al., 2007). Racial/ethnic minorities, persons of lower socioeconomic status, and younger persons are less likely to receive clinician-delivered cessation interventions (Danesh et al., 2014, Browning et al., Rabbit polyclonal to ITPKB 2008, Ferketich et al., 2014). Patient comorbidity and time spent with the physician are also associated with lower probability of receiving smoking cessation interventions in clinical care (Jamal et al., 2015, Ferketich et al., 2006, Silfen et al., 2015). In this study, we examined the prevalence of receipt of clinician-delivered 5As among patients in two diverse primary care clinics and one HIV care clinic and patient-related factors associated with receipt of the 5As. Consistent with previous studies (Park et al., 2015, Ferketich et al., 2006, Jamal et al., 2012), we hypothesized that receipt of Ask, Advise, and Assess would be higher than Assist and Arrange. We hypothesized that receipt of 5As would vary by clinic because of the distribution of patient comorbidity, and that patients with HIV/AIDS and those with mental health disorders or substance use.

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