An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial

Abstract

BackgroundThe provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services.Methods/designA cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care.DiscussionIf effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12615000204549. Registered on 3 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1401-6) contains supplementary material, which is available to authorized users.

Reducing Smoking Among People With Schizophrenia: Perspectives on Priorities for Advancing Research

“…Shifting health care systems and culture, building the capacity and confidence of clinical staff to address smoking and implementing smoke free policies are challenging changes within organizations. Emerging research however suggests that systems and organizational change interventions may provide a sustainable approach to integrating smoking cessation support in settings that care for people with schizophrenia (27–29).…”

Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster‐randomized controlled trial

“…The intervention included eight core components to support changing the culture and performance of the service to include more smoking cessation support for people who smoke: (1) engage organizational support ; (2) identify and support a champion ; (3) promote centre policies that support and provide tobacco dependence services ; (4) implement a system of identifying smokers ; (5) provide education and resources ; (6) provide staff and client feedback regarding smoke‐free policy and smoking cessation care and support ; (7) use of evidence‐based cessation treatments ; and (8) maintenance and follow‐up . A brief intervention description appears in Supporting information, Table S1; a full description appears in the published protocol paper .…”

“…The AOD services (clusters) were the unit of randomization. The full study protocol has been described in detail . Briefly, following randomization, all 32 AOD services assisted with the recruitment of their clients into the baseline survey over a 6‐month period.…”

“…Randomization was undertaken using generation of random uniform values. The randomization process is described in detail elsewhere .…”

No smoker left behind: it's time to tackle tobacco in Australian priority populations

“…Practice change and organisational change interventions may need to be multicomponent, including strategies such as policy development, staff training, provision of resources and tools, nicotine replacement therapy grants and re‐engineering organisational systems to support routine delivery of smoking cessation care. For example, the Cancer Council New South Wales Tackling Tobacco Program has increased the delivery of smoking cessation support within welfare agencies, homelessness services, drug and alcohol services, and mental health services in NSW 19 . Recognising the importance of these types of interventions, the New Zealand government set goals that “95% of hospitalised smokers and 90% of patients who smoke in primary care” 20 should be provided with brief advice to quit or referred to other cessation services.…”