12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics

Flocke, Susan A.; Seeholzer, Eileen; Lewis, Steven; Gill, India; Rose, Johnie; Albert, Elizabeth; Love, Thomas E.; Kaelber, David C.

doi:10.1007/s11606-020-06030-7

Cited by 19 publications

(19 citation statements)

References 27 publications

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“…The programs and studies were conducted in many different settings, but most often in a specialized clinic, including clinics for cancer, pediatrics, antenatal care, family planning, internal medicine, or pulmonary medicine ( n = 14), 29 , 30 , 39 , 43 , 45–48 , 51 , 55–57 , 59 , 61 primary care or general practice ( n = 11), 26 , 29 , 33 , 36–38 , 40 , 52 , 53 , 55 , 60 or a hospital ( n = 5). 34 , 41 , 42 , 44 , 50 Several studies were also conducted in a community or outpatient clinic which primarily serves low-income smokers ( n = 3), 32 , 54 , 58 dental practices ( n = 2), 31 , 40 a pharmacy ( n = 1), 49 and community sites such as housing estates, shopping malls, and public transport hubs ( n = 1).…”

Section: Resultsmentioning

confidence: 99%

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Westen-Lagerweij

Walters

Potyka

et al. 2022

Nicotine &Amp; Tobacco Research

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Introduction Behavioral smoking cessation programs are an effective tool for quitting smoking, yet remain underused by smokers. Proactive referral may be a promising strategy for healthcare staff to connect smokers to such programs. The aim of this study was to gain insight into the effectiveness and implementability of proactive referral of smokers to behavioral smoking cessation programs by healthcare staff. Methods A systematic review was conducted using five databases. Effectiveness of proactive referral was defined as the proportion of referred smokers who enrolled in a behavioral smoking cessation program. To determine the implementability of proactive referral, measures of feasibility, acceptability, adoption and referral rates were included as variables of interest. Out of 6,686 screened records, 34 articles were eligible for review. A narrative synthesis approach was used. Results The majority of the included studies investigated proactive referral within an e-referral system, combined with one or more intervention components which enhance implementation. Overall, proactive referral resulted in higher enrolment rates, especially among low-income smokers, and was found to be feasible, adoptable, and acceptable to healthcare staff. E-referral systems performed better in terms of implementability compared to fax referral systems. About half of the studies were of good quality. Many studies lacked information which resulted in lower quality scores. Conclusions The literature provides evidence that the proactive referral of smokers to behavioral smoking cessation programs by healthcare staff is effective and implementable across different settings. Based on the results, e-referral systems may be preferable to fax referral systems in terms of implementability. Implications This systematic review demonstrated that proactive referral has the potential to increase the reach of smoking cessation programs and reduce inequalities in the access to such programs. In the selection and implementation of behavioral smoking cessation programs with a proactive referral component, stakeholders (e.g., policymakers, healthcare funders, and healthcare professionals) may benefit from taking different aspects of proactive referral systems into account, such as the type of proactive referral system used and additional strategies which can enhance the implementability of the system.

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Section: Resultsmentioning

confidence: 99%

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Westen-Lagerweij

Walters

Potyka

et al. 2022

Nicotine &Amp; Tobacco Research

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“…The low adoption of the TMCP approach limits the ability to examine its impact in concert with the AAC. The AAC shows good reach and impact in this initiative and elsewhere, [ 9 , 16 ] but an important role for clinicians in providing tobacco cessation support remains. Specifically, the influence of a quit message from a clinician reinforces the importance and priority of tobacco cessation, especially in the context of patient symptoms or chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to the baseline period for this study, all eight clinics engaged in an AAC system change initiative to improve the provision of tobacco cessation support [ 16 ]. The systems change engaged MAs/RNs to use an electronic health record (EHR) supported AAC strategy.…”

Section: Methodsmentioning

confidence: 99%

A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support

et al. 2021

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Introduction This study examines the uptake of a clinician-focused teachable moment communication process (TMCP) and its impact on patient receipt of tobacco cessation support. The TMCP is a counseling method that uses patient concerns to help clinicians guide behavior change discussions about tobacco. We evaluate the added value of the TMCP training in a health system that implemented an Ask-Advise-Connect (AAC) systems-based approach. Methods A stepped wedge cluster randomized trial included eight community health centers. Training involved a web module and onsite skill development with standardized patients and coaching. Main outcome measures included contact and enrollment in cessation services among patients referred for counseling, prescription of cessation medications and quit attempts. Results Forty-four of 60 eligible clinicians received the TMCP training. Among TMCP-trained clinicians 68% used a TMCP approach (documented by flowsheet use) one or more times, with the median number of uses being 15 (IQR 2–33). Overall, the TMCP was used in 661 out of 8198 visits by smokers (8%). There was no improvement in any of the tobacco cessation assistance outcomes for the AAC + TMCP vs. the AAC only period. Visits where clinicians used the TMCP approach were associated with increased ordering of tobacco cessation medications, (OR = 2.6; 95% CI = 1.9, 3.5) and providing advice to quit OR 3.2 (95% CI 2.2, 4.7). Conclusions Despite high fidelity to the training, uptake of the TMCP approach in routine practice was poor, making it difficult to evaluate the impact on patient outcomes. When the TMCP approach was used, ordering tobacco cessation medications increased. Implications Tobacco cessation strategies in primary care have the potential to reach a large portion of the population and deliver advice tailored to the patient. The poor uptake of the approach despite high training fidelity suggests that additional implementation support strategies, are needed to increase sustainable adoption of the TMCP approach. Trial Registration clinicaltrials.gov #NCT02764385, registration date 06/05/2016.

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“…Studies have highlighted a role for telehealth in providing cessation care, 21 particularly during the pandemic when health systems resources were constrained. In Virginia, a military health facility used social media, email, and online patient portals to inform patients of cessation resources.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 While health systems have optimized their in-person delivery of smoking cessation care, they have had to make adaptations for telehealth during the COVID-19 pandemic. [17][18][19][20] Studies have highlighted a role for telehealth in providing cessation care, 21 particularly during the pandemic when health systems resources were constrained. In Virginia, a military health facility used social media, email, and online patient portals to inform patients of cessation resources.…”

Section: Introductionmentioning

confidence: 99%

System-Level Quality Improvement Initiatives for Tobacco Use in a Safety-Net Health System During the COVID-19 Pandemic

Chung

Rafferty

Suen

et al. 2022

J Prim Care Community Health

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Introduction: The shift from in-person care to telemedicine made it challenging to provide guideline-recommended tobacco cessation care during the COVID-19 pandemic. We described quality improvement (QI) initiatives for tobacco cessation during the COVID-19 pandemic, focusing on African American/Black patients with high smoking rates. Methods: The QI initiatives took place in the San Francisco Health Network, a network of 13 safety-net clinics in San Francisco, California between February 2020 and February 2022. We conducted direct patient outreach by telephone and increased staff capacity to increase cessation care delivery. We examined trends in tobacco screening, provider counseling, and best practice for cessation care (ie, the proportion of patients receiving at least 1 smoking cessation service during a clinical encounter). Results: In-person visits at the onset of the pandemic was 20% in April 2020 and increased to 67% by February 2022. During this time, tobacco screening increased from 29% to 74%. From March 2020 to March 2021, 34% more patients received provider counseling by telephone than in-person. The trend reversed from April 2021 to February 2022, where 23% more patients received counseling in-person than by telehealth. Best practice care increased by 23% from June 2020 to February 2022: 24% for African American/Black patients and 23% for other patients. Conclusions: Telehealth adaptations to the EHR, targeted outreach to patients, and a multi-disciplinary medical team may be associated with increases in cessation care delivery during the COVID-19 pandemic.

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12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics

Cited by 19 publications

References 27 publications

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support

System-Level Quality Improvement Initiatives for Tobacco Use in a Safety-Net Health System During the COVID-19 Pandemic

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