The use of 'academic detailing' to promote tobacco-use cessation counseling in dental offices

Background. The authors conducted this study to ascertain the feasibility of face-to-face educational outreach visits, also called "academic detailing," as a methodology to promote dentists' adoption and incorporation of tobacco-use cessation counseling activities into their practices. Methods. The authors obtained a a sampling frame of one dental health maintenance organization's, or DHMO's, enrolled dentists who practiced in one of four Northeastern states and who had more than 300 DHMO patients. Of 507 eligible dentists, 88 agreed to participate, and the authors randomly assigned them to either intervention (an academic detailing program) or control (practice as usual) conditions. Changes in practice behaviors over time were obtained by questionnaires. The authors used descriptive statistics to analyze data using a statistics software package. Results. Only 9 percent of dentists who agreed to participate had received any training in decreasing patients' tobacco use. The authors associated the dentists' staff members' considerable resistance to the detailing program with issues such as having to deal with additional paperwork and uncooperative patients, the perception that only a few patients use tobacco and that counseling does not work. Many dentists also expressed concern about their lack of tobacco-use cessation knowledge. Overall, dentists' resistance to detailing decreased with follow-up detailing visits. Conclusions. It is feasible to increase and incorporate tobacco-use cessation counseling in dental offices. However, significant barriers must be surmounted first if this goal is to be achieved by use of academic detailing. Clinical Implications. Using academic detailing, dentists can be effective agents in increasing the longevity, decreasing the morbidity and improving the oral health status of their patients through the promotion of smoking cessation.