Designing for Sustainability: An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care

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

doi:10.1016/j.jcjq.2019.09.003

Cited by 12 publications

(19 citation statements)

References 22 publications

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“…19 Commitment and support from all clinical and administrative staff may require adjustment to existing roles to promote a multilevel approach to smoking cessation care across health services. 22 The development of smoking cessation clinical guidelines and protocols, supported by staff training and regular monitoring and evaluation, will facilitate implementation of smoking cessation care into routine practice. 23 24 Empathetic words from participants towards patients and colleagues who smoke suggested recognition of the stigma surrounding smoking and understanding of the difficulties of attempting to quit.…”

Section: Discussionmentioning

confidence: 99%

Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study

et al. 2021

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ObjectiveTo explore the perspectives of hospital staff regarding the provision of smoking cessation care.Study designA qualitative description study using focus group discussions.Study settingData were collected across metropolitan regional and rural hospitals in Victoria, Australia, between November and December 2019.ParticipantsClinical and non-clinical hospital staff.ResultsFive focus groups were conducted across four hospitals. Staff (n=38) across metropolitan regional and rural hospitals shared similar views with regards to barriers and facilitators of smoking cessation care. Four themes were present: (1) Clinical Setting wherein views about opportunity and capacity to embed smoking cessation care, relevant policies and procedures and guidelines were discussed; (2) Knowledge consisted of the need for training on the provision of pharmacotherapy and behavioural interventions, and awareness of resources; (3) Consistency represented the need for a consistently applied approach to smoking cessation care by all staff and included issues of staff smoking; and (4) Appropriateness consisted of questions around how smoking cessation care can be safely delivered in the context of challenging patient groups and different settings.ConclusionsStaff across metropolitan regional and rural hospitals experience similar views and identified shared barriers in implementing smoking cessation care. Responding to staff concerns and providing support to address smoking with patients will help to foster a consistent approach to cessation care. Clear practice guidelines for multidisciplinary clinical roles need to underpin staff training in communication skills, include priorities around smoking cessation care, and provide the authorising environment in which clinical staff actively provide smoking cessation care.

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Section: Discussionmentioning

confidence: 99%

Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study

et al. 2021

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“…This data also strengthened existing research on the sustainability of tobacco treatment programs by including 1) a longer post-implementation periods and 2) both reach and effectiveness outcomes. Flocke et al [ 28 ] report improved and sustained reach of tobacco treatment delivery by comparing data during 3 months pre- and 6 months post-implementation of a EHR-based program in the primary care setting [ 28 ]. Baker and colleagues [ 26 ] examined reach of an EHR based referral system over 4 months pre-implementation and 8 months post-implementation; this showed elevated, but declining rates of electronic referral post-implementation.…”

Section: Discussionmentioning

confidence: 99%

Point of care tobacco treatment sustains during COVID-19, a global pandemic

Craig

Ramsey

Baker

et al. 2022

Cancer Epidemiology

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“…This is the first study that has sought to implement AAC in clinics with low IT resources and more constrained EHRs; clinics that have previously implemented AAC were a part of a large network that used a single, highly customizable EHR, with strong local IT support. 39 This is an important effort since it is well documented that low-resource settings have lower adoption of certain EHR capabilities. 20 The workflow analysis and the collection of input from front-line clinicians and staff on the optimal AAC workflow produced several refinements to the workflow that may further improve clinician satisfaction and efficiency.…”

Section: Discussionmentioning

confidence: 99%

Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers

et al. 2021

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Objective Tobacco use is the leading cause of preventable morbidity and mortality in the United States. Quitlines are effective telephone-based tobacco cessation services but are underutilized. The goal of this project was to describe current clinical workflows for Quitline referral and design an optimal electronic health record (EHR)-based workflow for Ask-Advice-Connect (AAC), an evidence-based intervention to increase Quitline referrals. Materials and methods Ten Community Health Center systems (CHC), which use three different EHRs, participated in this study. Methods included: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the EHR ecosystem in each CHC. Data across these methods were integrated and coded according to the Fit between Individual, Task, Technology and Environment (FITTE) framework. The current and optimal workflow were notated using Business Process Modelling Notation. We compared the requirements of the optimal workflow with EHR capabilities. Results Current workflows are inefficient in data collection, variable in who, how, and when tobacco cessation advice and referral are enacted, and lack communication between referring clinics and the Quitline. In the optimal workflow, medical assistants deliver a standardized AAC intervention during the visit intake. Referrals are submitted electronically, and there is bidirectional communication between the clinic and Quitline. We implemented AAC within all three EHRs; however, deviations from the optimal workflow were necessary. Conclusion Current workflows for Quitline referral are inefficient and ineffective. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.

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Designing for Sustainability: An Approach to Integrating Staff Role Changes and Electronic Health Record Functionality Within Safety-Net Clinics to Address Provision of Tobacco Cessation Care

Cited by 12 publications

References 22 publications

Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study

Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study

Point of care tobacco treatment sustains during COVID-19, a global pandemic

Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers

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