Smoking Status as the New Vital Sign: Effect on Assessment and Intervention in Patients Who Smoke
Section snippets
METHODS
The research site was the General Internal Medicine Clinic (GIMC) at the University of Wisconsin Hospitals and Clinics. Baseline and intervention (the expansion of the vital signs to include smoking status) data were collected during a 16-month period from 1991 to 1993 by using anonymous inperson surveys of patients as they exited the clinic. During this period, the GIMC was staffed by 47 physicians and 5 nurse-practitioners. Approximately 28,000 patients made 50,000 visits per year to this
RESULTS
The baseline survey was completed by 870 patients, including 80 current smokers (9.2%); 994 patients, including 165 smokers (16.6%), completed surveys during the intervention phase (Table 1). At baseline, about 60% of the sample was female and the mean age was 45 years (SD = 17.7). During the intervention phase, approximately 54% of patients surveyed were female and the mean age was 48 years (SD = 17.9). At the time of these surveys, the overall prevalence rate for smoking in Madison,
DISCUSSION
The survey data reported herein suggest that expanding the vital signs to include smoking status is an extremely potent intervention. This simple change in the operation of a general internal medicine clinic along with brief staff training was associated with a substantial increase in both the rate of assessment of smoking status and the rate of intervention in patients identified as smokers. If these findings are systematically replicated, this easy, low-cost, institutional change will provide
CONCLUSION
In this initial study, expansion of the vital signs to include smoking status was associated with significantly increased rates of identification of patients who smoke and intervention to inquire about and discourage cigarette smoking. If these findings prove generalizable, inclusion of smoking status as a vital sign will provide a simple, effective, and Smokers low-cost method of intervening clinically with the chief avoidable cause of illness and death in our society—use of tobacco.18
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This study was supported in part by Preventive Oncology Research Grant K-07 CA 015441-03 from the National Cancer Institute, National Institutes of Health, Public Health Service.