Optimizing Smoking Cessation Counseling in a University Hospital: Results and Pitfalls

Abstract

BackgroundHealthcare professionals (HPs) can play a substantial role in smoking cessation counseling (SCC) but in practice often skip this task due to time constraints. This study evaluates the implementation of the rapid Ask-Advise-Connect (AAC) method in a University hospital setting.MethodsThis mixed methods pre-post interventional study was performed at the Cardiology department of a University hospital and consisted of (1) a quantitative assessment of patient smoking registration and HP connection rates to external SCC from the Electronic Medical Record, (2) semi-structured interviews with 10 HPs to assess their attitudes toward AAC, and (3) a blended intervention aimed to implement AAC. The blended intervention consisted of face-to-face and online AAC psychoeducation for HPs followed-up with motivational messages on their smart pagers over a period of 6 weeks.ResultsIn total, 48,321 patient registrations and 67 HPs were included. Before AAC implementation, HPs assessed smoking status in 74.0% of patients and connected 9.3% of identified smokers with SCC. Post intervention, these percentages did not increase (73.2%, p = 0.20; and 10.9%, p = 0.18, respectively). Nonetheless, the vast majority (90%) of HPs feel it is important to discuss patient smoking, and view it as their duty to do so. Main barriers to AAC reported by HPs were forgetfulness and time pressure.ConclusionThis study shows that this AAC intervention does not increase Asking after smoking status or Connection of patients to SCC in a University Hospital. However, HPs hold positive attitudes toward AAC. A better understanding of the mechanisms required for optimizing HPs practice behavior is needed.

Healthcare providers’ knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape

“…This study found that most HCPs agreed that counselling on smoking was an important part of their job. This was supported by other studies (De Frel et al 2022;Ilesanmi et al 2021;Van Zyl-Smit et al 2013). However, Mahoto et al in their study in the Zambezi region, reported that although the majority of HCPs regard themselves as providers of preventive healthcare, they do not necessarily consider the provision of smoking cessation intervention as part of their duty (Mahoto et al 2023).…”

Implementation of ask-advise-connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: a mixed-methods evaluation using the CFIR framework

“…For example, developing systems for building smoking cessation care into practice may help GPs to routinely carry out AAC. This may include incorporating an alert in the EHR which reminds GPs to ask about smoking, as well as a referral option in the EHR which automatically sends the patient’s contact details to a smoking cessation specialist who then may proactively contact the patient for an intake [ 11 – 14 , 16 , 17 ].…”

“…The Ask-Advise-Connect (AAC) approach is a brief and effective method which includes the abovementioned steps (i.e., asking patients about tobacco use, advising all patients who smoke to quit, and proactively referring patients who smoke to counselling) [ 11 ]. Although the feasibility and effectiveness of AAC has already been studied in several healthcare settings [ 11 – 15 ], only a few studies have investigated which strategies are needed to successfully implement AAC in practice [ 16 , 17 ]. Specifically in stressful times, a comprehensive implementation strategy may be needed to implement AAC in practice.…”

The delivery of Ask-Advise-Connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: results of a pre-post implementation study

“…One study conducted in primary care found that a comprehensive AAC implementation strategy consisting of training, performance feedback reports and the incorporation of an e-referral functionality in the electronic health record, resulted in more patients being asked about smoking and more smokers being advised to quit and connected to cessation support [ 26 ]. However, another study conducted in a Dutch university hospital found that an AAC implementation strategy consisting of education and reminders through text messages did not result in more patients being asked about smoking or more smokers being connected to a smoking cessation program [ 27 ]. According to the researchers the lack of an effect could be explained by other priorities and time pressure on the healthcare providers [ 27 ].…”

“…However, another study conducted in a Dutch university hospital found that an AAC implementation strategy consisting of education and reminders through text messages did not result in more patients being asked about smoking or more smokers being connected to a smoking cessation program [ 27 ]. According to the researchers the lack of an effect could be explained by other priorities and time pressure on the healthcare providers [ 27 ].…”