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CMAJ • September 4, 2001; 165 (5)
© 2001 Canadian Medical Association or its licensors

Review
Synthèse

Physicians Taking Action Against Smoking: an intervention program to optimize smoking cessation counselling by Montreal general practitioners

Michèle Tremblay*{dagger}, André Gervais*{dagger}, Chantal Lacroix*{dagger}, Jennifer O'Loughlin*{ddagger}, Hela Makni* and Gilles Paradis*{dagger}{ddagger}

From *Direction de la santé publique, Régie régionale de la santé et des services sociaux de Montréal-Centre, Montreal, Que.; the {dagger}Division of Preventive Medicine, McGill University Health Center, Montreal, Que.; and the {ddagger}Joint Departments of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Que.

Correspondence to: Dr Michèle Tremblay, Direction de la santé publique, Régie régionale de la santé et des services sociaux de Montréal-Centre, 1301, rue Sherbrooke Est, Montréal QC H2L 1M3; fax 514 528-2425; mtrembl1{at}santepubl-mtl.qc.ca

Abstract

IN 1997 THE DIRECTION DE LA SANTÉ PUBLIQUE de Montréal-Centre initiated "Physicians Taking Action Against Smoking," a 5-year intervention program to improve the smoking cessation counselling practices of general practitioners (GPs) in Montreal. Program development was guided by the precede-proceed model. This model advocates identifying factors influencing the outcome, in this case counselling practices. These factors are then used to determine the program objectives, to develop and tailor program activities and to design the evaluation. Program activities during the first 3 years included cessation counselling workshops and conferences for GPs, publication of articles in professional interest journals, publication of clinical guidelines for smoking cessation counselling and dissemination of educational material for both GPs and smokers. The program also supported activities encouraging smokers to ask their GPs to help them stop smoking. Results from 2 cross-sectional surveys, conducted in 1998 and 2000, of random samples of approximately 300 GPs suggest some improvements over time in several counselling practices, including offering counselling to more patients and discussing setting a quit date. More improvements were observed among female than male GPs in both psychosocial factors related to counselling and specific counselling practices. For example, improvements were noted among female GPs in self-perceived ability to provide effective counselling and in the belief that it is important to schedule specific appointments to help patients quit; in addition, the perceived importance of several barriers to counselling decreased among female GPs. A greater proportion of the female respondents to the 2000 survey offered written educational material than was the case in 1998, and a greater proportion of the male GPs devoted more time to counselling in 2000 than in 1998; however, among male GPs the proportion who discussed the pros and cons of smoking with patients in the precontemplation stage declined between 1998 and 2000, as did the proportion who referred patients in the preparation stage to community resources. Our experience suggests that an integrated, theory-based program to improve physicians' counselling practices could be a key component of a comprehensive strategy to reduce tobacco use.




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