The experience of Group Health Cooperative of Puget Sound (GHC) in the development and implementation of strategies to decrease tobacco use is an encouraging story. The conclusion to this story is that implementation of the major recommendations of the Agency for Health Care Policy and Research’s (AHCPR’s) evidence-based smoking cessation guideline can be done. The accomplishments described in this paper have occurred over the past 12 to 15 years. It is important to note that managed care organisations who are beginning this work now have a lot of advantages compared with when we started in the 1980s.

Group Health Cooperative (GHC) is a group model, not-for-profit health maintenance organisation (HMO). It was a staff model HMO until January 1998. GHC serves over 450 000 enrollees who receive their care at approximately 25 different medical centres in the Puget Sound [Seattle, Washington] area. Our primary care practice panel sizes are about 2000, and there are approximately 200 primary care practices. The population that receives their care at GHC is demographically representative of the population in the region. A key feature of GHC is the extensive automated clinical systems, including automated enrolment systems which allow one to identify population-based samples of enrollees, automated appointment systems, automated data on the use of laboratory and radiography facilities and automated pharmacy systems. To date, however, there is no automated registry or clinical information system that routinely tracks the smoking status of enrollees.