Targeting primary care referrals to smoking cessation clinics does not improve quit rates

Implementing evidence-based interventions into practice

Elizabeth M. Yano, Lisa V. Rubenstein, Melissa M. Farmer, Bruce A. Chernof, Brian S. Mittman, Andrew B. Lanto, Barbara F. Simon, Martin L. Lee, Scott Sherman

    Research output: Contribution to journalArticle

    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.

    Original languageEnglish (US)
    Pages (from-to)1637-1661
    Number of pages25
    JournalHealth Services Research
    Volume43
    Issue number5 P1
    DOIs
    StatePublished - Oct 1 2008

    Fingerprint

    Smoking Cessation
    Primary Health Care
    Quality Improvement
    Veterans Health
    Referral and Consultation
    United States Department of Veterans Affairs
    Guidelines
    Population
    Tobacco Use Disorder
    Aptitude
    Process Assessment (Health Care)
    Information Storage and Retrieval
    Health Facilities
    Telephone
    Health Status
    Smoking
    Surveys and Questionnaires

    Keywords

    • Quality of health care
    • Smoking cessation
    • Veterans

    ASJC Scopus subject areas

    • Health Policy

    Cite this

    Targeting primary care referrals to smoking cessation clinics does not improve quit rates : Implementing evidence-based interventions into practice. / Yano, Elizabeth M.; Rubenstein, Lisa V.; Farmer, Melissa M.; Chernof, Bruce A.; Mittman, Brian S.; Lanto, Andrew B.; Simon, Barbara F.; Lee, Martin L.; Sherman, Scott.

    In: Health Services Research, Vol. 43, No. 5 P1, 01.10.2008, p. 1637-1661.

    Research output: Contribution to journalArticle

    Yano, EM, Rubenstein, LV, Farmer, MM, Chernof, BA, Mittman, BS, Lanto, AB, Simon, BF, Lee, ML & Sherman, S 2008, 'Targeting primary care referrals to smoking cessation clinics does not improve quit rates: Implementing evidence-based interventions into practice', Health Services Research, vol. 43, no. 5 P1, pp. 1637-1661. https://doi.org/10.1111/j.1475-6773.2008.00865.x
    Yano, Elizabeth M. ; Rubenstein, Lisa V. ; Farmer, Melissa M. ; Chernof, Bruce A. ; Mittman, Brian S. ; Lanto, Andrew B. ; Simon, Barbara F. ; Lee, Martin L. ; Sherman, Scott. / Targeting primary care referrals to smoking cessation clinics does not improve quit rates : Implementing evidence-based interventions into practice. In: Health Services Research. 2008 ; Vol. 43, No. 5 P1. pp. 1637-1661.
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