My Take
Referral Might Be More Realistic
The systematic review by Dr. Lai and his colleagues affirms the general notion that interventions for tobacco cessation provided by clinicians increase abstinence rates, but also goes further to suggest that primary care physicians may be more effective than other clinicians.
As the authors point out, this conclusion must be interpreted with caution because it is based on two small studies. Even if the authors' conclusion are true, motivational interviewing is an incredibly powerful tool—but one with limited ability to be disseminated into primary care practices. The “crush of the practice” in primary care leaves only the optimistic and detached remaining hopeful that providers will be able to apply these skills with their patients who use tobacco.
A more realistic model is the AAR model in which busy clinicians Ask-Advise-Refer. The ideal role of motivational interviewing in primary care may be to overcome patient barriers to accepting referral to a tobacco treatment specialist or to picking up the phone and calling the tobacco quit line (800-QUITNOW).