Journal Club: Feasibility of Tobacco Interventions in Anesthesiology Practices Troy Tada, DO August 26, 2009

End points of Study Determine if the AAR strategy will be well accepted into modern day anesthesiology practices

Choice of Article Many of our patients do smoke Smoking does make an impact on our anesthetic plan Smokers do have an increased risk for pulmonary complication with general anesthesia What can we do to assist PCP with smoking cessation

Method 14 anesthesiology practices (academic-5 and private-9) Implement AAR (ask, advise, refer) for 3 months 9 practices were presented with in-service training for rationale and strategy 5 practices received material to be distributed to staff

Method Two surveys given to all practices after 3 months 1st survey Amount of time spent learning Self-efficacy Rate at which strategy was used Attitude towards AAR 2nd survey Number of docs in group received the 1st survey Plans on continuing strategy

Results 95 completed surveys 76% physicians Reported frequently or almost always performing each element of the AAR strategy About 50% felt that their patient frequently or almost always seemed interested 33% interested in quitlines 90% respondents useful

results Majority  responsibility to advise pts to quit Majority thought quitlines useful 23%  not enough time to apply strategy Majority planned to utilize AAR in practice

Bottom line AAR approach to tobacco intervention was well-accepted in anesthesiology practices

Limitations No follow up surveys No studies showing which technique is most efficient Most respondents did not receive formal training

What do we do? All ask if pt does smoke Should we implement a smoking cessation intervention strategy Alcohol drugs

Open discussion