Increasing Rates of Tobacco Treatment Delivery in Primary Care Practice: Evaluation of the Ottawa Model for Smoking Cessation

Abstract

PURPOSEWe report on the effectiveness of the Ottawa Model for Smoking Cessation (OMSC), a multicomponent knowledge translation intervention, in increasing the rate at which primary care providers delivered smoking cessation interventions using the 3 A's model-Ask, Advise, and Act, and examine clinic-, provider-and patient-level determinants of 3 A's delivery. METHODSWe examined the effect of the knowledge translation intervention in 32 primary care practices in Ontario, Canada, by assessing a cross-sectional sample of patients before the implementation of the OMSC and a second crosssectional sample following implementation. We used 3-level modeling (clinic, clinician, patient) to examine the main effects and predictors of 3 A's delivery. RESULTSFour hundred eighty-one primary care clinicians and more than 3,500 tobacco users contributed data to the evaluation. Rates of delivery of the 3 A's increased significantly following program implementation (Ask: 55.3% vs 71.3%, P <.001; Advise: 45.5% vs 63.6%, P <.001; Act: 35.4% vs 54.4%, P <.001). The adjusted odds ratios (AOR) for the delivery of 3 A's between the pre-and postassessments were AOR = 1.94; (95% CI, 1.61-2.34) for Ask, AOR = 1.92; (95% CI, 1.60-2.29) for Advise, and AOR = 2.03; (95% CI, 1.71-2.42) for Act. The quality of program implementation and the reason for clinic visit were associated with increased rates of 3 A's delivery.CONCLUSIONS Implementation of the OMSC was associated with increased rates of smoking cessation treatment delivery. High quality implementation of the OMSC program was associated with increased rates of 3 A's delivery.

Managing smoking cessation

“…One approach that has been widely disseminated in Canada (> 350 sites) is the Ottawa Model for Smoking Cessation -a proven process for integrating tobacco-dependence treatments within clinical settings. 5,[32][33][34][35] The Ottawa Model for Smoking Cessation ensures providers receive training in treatment for tobacco dependence, and introduces reminders (e.g., prompts by electronic medical records) and practice tools to ensure that all patients are asked about their smoking status, given unambiguous nonjudgmental advice to quit smoking, offered assistance in the form of pharmacotherapy and behavioural support, and offered ongoing follow-up (≥ 6 mo) (Figure 1). Implementation of the Ottawa Model for Smoking Cessation is associated with significant increases in long-term abstinence and improvements in health and utilization of health care among smokers in hospital settings (OR 1.71, 95% CI 1.11-2.64), 34,36 and in primary care settings (adjusted OR 3.10, 95% CI, 1.10-8.60).…”

Tobacco treatment TrAining Network in Crete (TiTAN-Crete): protocol for a controlled before-after study

“…The 'Ottawa Model for Smoking Cessation' (OMSC), is a multicomponent intervention for addressing tobacco use with smokers in primary care settings that is based on the 5A's model 11,18,19 . Evaluation of the OMSC program in Canadian primary care practices reveals a significant improvement in the rates at which evidence-based tobacco treatments are delivered in a large sample of primary care practices 11,20 . The extent to which this model can be used to influence the practice behaviors of primary care clinicians in countries such as Greece is unknown.…”

“…Heart Institute and which are specific to primary practice settings 20 . To facilitate maximum uptake the intervention program was adapted to reflect: language; cultural appropriateness; local patient beliefs and attitudes regarding tobacco-use and cessation; local social and clinical norms; provider perceptions surrounding 5As delivery; and practice characteristics.…”

“…Given the clustered design an inflation factor was used to enlarge the total sample size to account for loss in statistical power. Based on estimates generated from previous research we have estimated that the ICC will be 0.01 11,20 . We have estimated rates of provider 'advice' will be 45% in the Control Group, 60% in the Intervention Group.…”

In This Issue: Decisions, Decisions

“…10 Having patients measure their own waist circumference after written and pictorial instructions seems like a good idea, but is found to have a high false negative rate for assessing overweight, in a study by Jensen and colleagues. 11 The duration of effectiveness of a health coaching intervention for chronic disease management is examined by Sharma and colleagues.…”