There remains an ongoing need to reduce tobacco use in the U.S. Physician organizations,
such as medical groups, can support healthcare providers to be more effective in their
delivery of tobacco cessation by adopting practices recommended in the Public Health
Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (PHS Guideline).
To document the extent to which activities to reduce tobacco use, as recommended in
the PHS Guideline as system-level interventions, are provided within large medical
groups in the U.S.
During 2006–2007, data were collected on 339 medical groups operating in the U.S.,
with 20 or more physicians treating at least one of four chronic conditions. Organizations
were surveyed regarding activities to reduce tobacco use as recommended in the PHS
Guideline as system-level interventions (i.e., tobacco-use status documentation, policies
to promote provider interventions, and staff dedicated to treating tobacco dependence).
Between 2008 and 2009, bivariate associations and multivariate logistic regression
models assessed the relationship of organizational characteristics and external incentives
with adoption of systems strategies for treating tobacco dependence.
Nearly 83% of medical groups with 20 or more physicians operating in the U.S. in 2006–2007
have adopted one or more strategies recommended as effective to support the treatment
of tobacco dependence. However, only 5.6% of medical groups engage in all eight tobacco
control activities examined in this study. The two factors that were associated most
consistently with medical group policies to treat tobacco dependence were the patient-centeredness
of the organization and participation in a quality demonstration program.
There is much room for improvement in increasing medical group adoption of systems
strategies to reduce tobacco use. The findings in this paper suggest recommendations
to achieve these improvements.