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Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice.

Abstract：

OBJECTIVE:To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. DATA SOURCES/STUDY SETTING:We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. STUDY DESIGN:In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. DATA COLLECTION:To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n=1,941) and follow-up at 12 months (n=1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health status, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. PRINCIPAL FINDINGS:Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p<.0001), we found no intervention effect on smoking cessation. CONCLUSIONS:EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level.

journal_name

Health Serv Res

journal_title

Health services research

authors

Yano EM,Rubenstein LV,Farmer MM,Chernof BA,Mittman BS,Lanto AB,Simon BF,Lee ML,Sherman SE

doi

10.1111/j.1475-6773.2008.00865.x

subject

Has Abstract

pub_date

2008-10-01 00:00:00

pages

1637-61

issue

5 Pt 1

eissn

0017-9124

issn

1475-6773

pii

HESR865

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice.