Facilitators of health systems change for tobacco dependence treatment: a qualitative study of stakeholders? perceptions

Abstract

BackgroundHealth systems play key roles in identifying tobacco users and providing evidence-based care to help them quit. Health systems change – changes to health care processes, policies and financing – has potential to build capacity within these systems to address tobacco use. In 2010, ClearWay MinnesotaSM piloted a health systems change funding initiative, providing resources and technical assistance to four health care systems. This paper presents findings from a process evaluation, describing key stakeholders’ views on whether changes to how health systems treat tobacco use resulted from this initiative and what may have facilitated those changes.MethodsA process evaluation was conducted by an independent evaluation firm. A qualitative case study approach provided understanding of systems change efforts. Interviews were conducted with key informants representing the health systems, funder and technical assistance providers. Core documents were reviewed and compared to thematic analysis from the interviews. Results were triangulated with existing literature to check for convergence or divergence. A cross-case analysis of the findings was conducted in which themes were compared and contrasted.ResultsAll systems created and implemented well-defined written tobacco use screening, documentation and treatment referral protocols for every patient at every visit. Three implemented systematic follow-up procedures for patients referred to treatment, and three also implemented changes to electronic health records systems to facilitate screening, referral and reporting. Fax referral to quitline services was implemented or enhanced by two systems. Elements that facilitated successful systems changes included capitalizing on environmental changes, ensuring participation and support at all organizational levels, using technology, establishing ongoing training and continuous quality improvement mechanisms and leveraging external funding and technical assistance.ConclusionsThis evaluation demonstrates that health systems can implement substantial changes to facilitate routine treatment of tobacco dependence in a relatively short timeframe. Implementing best practices like these, including increased emphasis on the implementation and use of electronic health record systems and healthcare quality measures, is increasingly important given the changing health care environment. Lessons learned from this project can be resources for states and health systems likely to implement similar systems changes.

Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views

“…Consistent with an existing qualitative study of organisational change in healthcare settings [19], which shows the importance of an influential and current employee, staff reported that a support champion was essential to ensuring the successful maintenance of the intervention. Effective support champions are not those who just implement the intervention but serve as a local expert [20].…”

“…Drawing upon the healthcare reform literature [21], suggested strategies to address barriers, such as a lack of employee engagement, involve specific drivers: Staff are involved in the decision-making, the facility provides encouragement for development, and two-way dialogue with facility leaders and co-workers to create a reliable support team [22]. Providing these opportunities in an effort to address barriers, such as lack of engagement, will allow for services to efficiently implement the new processes and procedures within their setting [19].…”

Public Health and Health Care Partnerships for Improved Tobacco Cessation

“…The Health Systems Change Partnerships program was informed by Clinical Practice Guidelines for Treating Tobacco Use and Dependence and similar work in other communities. 19,22,23 The initiative's central focus was to leverage partnerships to support health systems in building capacity to develop system-level solutions to facilitate clinicians in consistently and effectively addressing tobacco use among their patients. Participating health care organizations were expected to develop systems change initiatives that focused on 3 areas: implementing best practices for tobacco dependence treatment; quality improvement; and utilization of an EHR system.…”

Sociodemographic characteristics of tobacco users as determinants of tobacco use screening done by healthcare providers: Global Adult Tobacco Survey India 2009-2010

“…[ 22 23 ] One study conducted in Minnesota showed that health systems also determine the tobacco use screening by physicians. [ 24 ] Electronic health records or paper documentation of tobacco use status, availability of nicotine gums/patches in pharmacy, training and education of staff, referral to tobacco cessation professionals, were some simple measures that facilitated tobacco use screening and treatment of patients. [ 24 ] Few studies have shown a correlation between present illness of patient and tobacco use screening by healthcare provider.…”

“…[ 24 ] Electronic health records or paper documentation of tobacco use status, availability of nicotine gums/patches in pharmacy, training and education of staff, referral to tobacco cessation professionals, were some simple measures that facilitated tobacco use screening and treatment of patients. [ 24 ] Few studies have shown a correlation between present illness of patient and tobacco use screening by healthcare provider. According to one study conducted in two Indian states (Andhra Pradesh and Gujarat), patients with respiratory illness were more likely to be screened for tobacco use by healthcare provider as compared to patients with general ailments.…”