Support for smoking cessation interventions in physician organizations: Institutional and resource dependence perspectives

Tobacco use has been identified as the single greatest preventable cause of death and disease in the United States, leading to more than 430,000 deaths annually. Although clinical practice guidelines highlight the importance of physician-based smoking cessation interventions to reduce tobacco use, research has shown that many smokers are not receiving the most basic smoking cessation interventions from their physician. As approximately 70% of all smokers visit their physician each year, health care professionals are missing a key opportunity to provide effective smoking cessation interventions.; One potentially effective method for increasing physician delivery of smoking cessation interventions is improved organizational support of smoking cessation interventions. Physician organizations, such as medical groups and independent practice associations (IPAs), can support smoking cessation interventions by: educating physicians about smoking cessation interventions, institutionalizing office-based systems to identify smoking status of all patients, and providing self-help materials and nicotine replacement therapy (NRT) starter kits. As physicians have joined physician organizations, the role that organizational practices and policies play in treating tobacco dependence is critical to examine.; This research project has three primary objectives. The first objective is to document the extent to which physician organizations nationally are providing organizational support for smoking cessation interventions. The second objective is to understand the institutional and resource dependence pressures in the health care environment that may influence physician organization support for smoking cessation interventions. The third objective is to examine the association between organizational support for smoking cessation interventions and physician behavior.; This research uses data from the first national survey of physician organizations (medical groups and IPAs with 20 or more physicians) to document the extent to which physician organizations are providing organizational support for smoking cessation interventions. Out of 1,592 physician organizations in the United States, 1,107 participated in this survey for a response rate of 70%.; Overall, 70% of physician organizations reported engaging in some form of support for smoking cessation interventions. Specifically, 39% of physician organizations offer smoking cessation health promotion programs, 17% require physicians to provide specific interventions, 15% evaluate the degree to which physicians provide interventions, 39% provide physicians with written materials on pharmacotherapy, 37% provide physicians with written materials on counseling, 58% provide self-help materials, and 25% provide NRT starter kits to distribute to patients. Factors positively associated with organizational support for smoking cessation interventions were: receiving additional income from health plans for scoring well on quality measures, receiving financial incentives from HMOs to promote smoking cessation interventions, being required to report on HEDIS measures, receiving public recognition for scoring well on quality measures, awareness of the 1996 AHCPR guideline on smoking cessation, being a medical group (compared to an IPA), having a higher percentage of primary care physicians, and non-physician ownership of the physician organization.; These findings provide a baseline on physician organization activities for treating tobacco dependence in the United States. They also suggest that the resource dependence and institutional pressures that physician organizations face to provide support for smoking cessation interventions have an effect on organizational behavior. These findings have implications for health care purchasers, health plans, physician organizations, physicians, consumers, and tobacco control advocates.