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a Mayo Medical School,
Rochester, Minnesota, USA, b Division of Epidemiology, School of Public
Health, University of Minnesota, Minneapolis, Minnesota, USA
Correspondence to: Dr Deborah J Hennrikus, Division of Epidemiology, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015, USA; hennrikus{at}epi.umn.edu
Received 13 November
1999; Revision received 17 June 2000;
Accepted 27 June 2000
OBJECTIVES
To
determine rates of patient reported and physician documented
counselling; to identify predictors of each report; and to identify the
impact of each report on smoking cessation attempts after discharge
from the hospital.
DESIGN
Stickers on
subjects' charts prompted physicians to give brief smoking cessation
counselling to patients in the hospital. Patients reported counselling
received and quit attempts in a phone interview conducted 7-18 days
after discharge. Rates of counselling and correlations were calculated,
and multivariate analysis identified predictors of patient report,
physician documentation, and quit attempts.
SETTING
Four hospitals
in the Minneapolis/St Paul metropolitan area.
SUBJECTS
682 hospital
patients who had smoked more than 100 cigarettes in their lifetime and
had smoked in the last three months.
RESULTS
71.0% of
patients reported counselling, and physicians documented counselling in
the charts of 46.2% of patients (correlation = 0.15,
= 0.13).
Patient report was predicted by specific hospital, belief that their
hospitalisation was smoking related, diagnosis of a smoking related
disease, and physician documentation of counselling. Physician
documentation was predicted by female patient, specific hospital,
longer hospital stay, and marginally predicted by smoking related
disease. Quit attempts were predicted by patient report of counselling,
but not physician documentation.
CONCLUSIONS
Physicians
document counselling in the hospital at a lower rate than patients
report it, and the correlation between reports is very low, making an
accurate assessment of true rates of counselling difficult. While it is
important to increase physician documentation, it is even more
important to increase patient recall, as this is the only report that
predicts a quit attempt.
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