Organizational and Provider Characteristics Fostering Smoking Cessation Practice Guideline Adherence

Abstract

We examined the relationship between physician adherence with a smoking cessation guideline and organizational structures, policies, leadership support, and physician knowledge and attitudes. A random sample of 844 physicians practicing in 127 VHA hospitals was surveyed. Survey results were aggregated to the hospital level and linked with data on organizational characteristics from the 1998 annual survey of hospitals by the American Hospital Association. Significant predictors of adherence included organizational policies related to nicotine replacement prescriptions, the timing and effectiveness of guideline implementation, physicians' knowledge of VHA clinical guidelines generally, and physicians' beliefs about the receptiveness of patients to smoking cessation.

A qualitative investigation of smoke-free policies on hospital property

“…Study findings affirm evidence that tobacco dependence treatment is inconsistently offered in hospitals [14][15][16][17][18]25,29 and heath providers were uninformed about tobacco dependence treatment, 29 despite availability of nicotine-replacement therapy at study sites. This treatment gap is perplexing, especially as within Canada there exists an evidence-based hospital tobacco dependence treatment program.…”

“…16,20,25 Like other researchers, we have found that when tobacco use is framed as a habit, health care providers are perplexed as to why people continue to smoke when faced with health concerns and restrictions, and consider such people to not be taking responsibility for their health. 25 This may be a root cause for the stigmatization of people who smoke, or at least for the lack of empathy toward them.…”

“…16,17,20,21,27 In the United Kingdom, where health institutions were to implement smoke-free policies by 2007, 4 this goal has nearly been achieved; however, patient noncompliance and staff reluctance to enforce the policy continue. 17,20 Participants suggested establishing enclosed designated smoking areas to diminish exposure to tobacco smoke and circumvent concerns for the safety of patients.…”

“…12 Unfortunately, most of the nearly five million Canadians who smoke will receive suboptimal treatment, 13 as the routine provision of interventions for tobacco dependence in hospital settings is not a practice norm. [14][15][16] In smoke-free hospitals, two studies suggest minimal support is offered for withdrawal, 17,18 and one reports an increased use of nicotinereplacement therapy after the implementation of the smoke-free policy. 19 Assessments of the effectiveness of smoke-free policies for hospital property tend to focus on noncompliance and related issues of enforcement.…”

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

“…Addressing barriers to the delivery of tobacco treatment including clinician knowledge, attitudes, skills, and time constraints is necessary to increase the uptake of tobacco treatment interventions in primary care settings 5,[14][15][16][17] . 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 .…”