Awareness and Implementation of the 2000 United States Public Health Service Tobacco Dependence Treatment Guideline in a Public Hospital System

Abstract

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.

The Head Start Tobacco Cessation Initiative: Using Systems Change to Support Staff Identification and Intervention for Tobacco Use in Low-Income Families

“…HS directors completed a modified Baseline Facility Survey (BFS) used in the public hospital system in Louisiana [7]. The directors of each HS site were asked to report on center practices and policies regarding tobacco use and cessation services, cessation interventions, efforts to monitor tobacco use among parents, budgets for tobacco control activities, tobacco control practices, policies of affiliated health care providers, and strategies and barriers to increase tobacco cessation activities.…”

“…The experience of this group in initiating systems change in organizations serving high-risk populations was integral to the development of Initiative guidelines, which were designed to enable participating sites to incorporate cessation identification and referral protocols into their existing infrastructures [7, 8]. This group developed protocols for implementing the Initiative and strategies for incorporating the Initiative into HS programs.…”

Use of systems change and health information technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare

“…The survey was adapted from a series of assessments conducted by the American Association of Health Plans (AAHP) a comprehensive and widely used appraisal of tobacco-related interventions in health care systems [23]. At each site, the survey was administered to representatives from relevant departments [24]. This study received exempt research status from the LSU Health Sciences Center Internal Review Board (IRB).…”