Background:

Environmental exposure to cigarette smoke causes numerous serious and costly health problems in children. Adults with children are likely to have more encounters with their child’s physician than with their own physician. Therefore, pediatricians are in a unique position to address the harmful effects of parental smoking and promote nonsmoking.

Previous studies of smoking cessation counseling by health care providers have identified multiple barriers including lack of skills and knowledge related to cessation counseling, perceived lack of time to provide the counseling, and lack of reimbursement for time invested in counseling. Most pediatricians are willing to give advice on smoking cessation to parents, but few pediatricians have received formal training in counseling adults regarding smoking cessation.

Objectives:

The objectives of this planning proposal are (1) to facilitate creation of pediatric office-wide systems to identify household smokers, (2) to develop a CD-ROM based training tool to train pediatric providers to perform cessation counseling, (3) to develop a reimbursement system for pediatricians who provide adult cessation counseling, and (4) to evaluate parents’ and pediatricians’ receptiveness to this approach.

Methodology:

The study population will include three selected pediatric practices in the Children’s Health System. CACH HMO, Inc., a pediatric-only HMO, will actively participate in development of the training tool. CACH HMO will also develop policies and mechanisms for reimbursement for smoking cessation counseling by pediatric primary care providers who satisfactorily complete the training course.

Baseline assessments in the form of physician questionnaires will determine baseline knowledge and describe current intervention practices in the participating offices. Surveys of pediatricians at the conclusion of the study will measure provider satisfaction with materials, training, and system changes. Parents of CACH patients with a counseling claim will be surveyed to determine how much intervention was done and how receptive parents were to the intervention. Parents will be mailed two surveys, one sent within 2 weeks of the visit and another at the conclusion of the study.

Charts with associated counseling claims will be retrospectively reviewed by CACH to (1) determine the frequency of smoking cessation interventions before versus after the intervention, and (2) validate use of claims data for analysis. Chart abstraction will include collection of demographic information and presence of chronic illnesses, as well as use of NRT and transitions to other providers (referrals to support groups, adult medical providers, or formal cessation programs).

Outcomes of interest:

Outcomes to be measured include: (1) frequency of physicians providing smoking cessation counseling before versus after the intervention, (2) agreement between chart documentation and submission of claims for smoking interventions, and (3) receptiveness of interventions by providers and parents.