Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record

Piper, Megan E.; Baker, Timothy B.; Mermelstein, Robin J.; Collins, Linda M.; Fraser, David; Jorenby, Douglas E.; Smith, Stevens S.; Christiansen, Bruce A.; Schlam, Tanya R.; Cook, Jessica W.; Oguss, Madeline; Fiore, Michael C.

doi:10.1007/s13142-012-0178-8

Cited by 38 publications

(31 citation statements)

References 52 publications

(67 reference statements)

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“…In a study recruiting from the general population of smokers seeking care in primary care, only 30 percent opted for a study arm for reducing smoking; 70% joined the study are for those who wanted to quit in the next 30 days (Piper, Baker, Mermelstein, Collins, Fraser, et al, 2013). Furthermore, of the 18% who did express the motivation to quit in the next 30 days, about half were not yet in the preparation stage of change.…”

Section: Discussionmentioning

confidence: 99%

Helping Smokers with Severe Mental Illness Who Do Not Want to Quit

Christiansen

Carbin

TerBeek

et al. 2017

Substance Use & Misuse

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Background People with a severe and persistent mental illness are far more likely to smoke than others. Importantly, a large portion of them would like to quit. Despite this desire, they are less likely to make quit attempts and succeed. Objective This study used an RCT to test an intervention designed to increase engagement in cessation treatment, quit attempts, and quitting in smokers who did not want to quit in the next 30 days. It also compared these smokers with those who were motivated to quit in the next 30 days. Methods Participants (N=222), smokers with significant mental illness receiving intensive outpatient care from Community Support Programs in Wisconsin who were not interested in quitting in the next 30 days, were randomly assigned to either an intervention group or an attention control group. The intervention, administered during four weekly sessions, included a motivational element, components designed to prepare the smoker for a quit attempt, and pre-quit nicotine patch. Additionally, 48 smokers motivated to quit in the next 30 days served as a comparison group. Results Compared to control participants, smokers receiving the intervention were more likely to be abstinent (7 day point prevalence) at the three month follow-up (biochemically verified, intent to treat, 8.5% vs. 1.0%, respectively, p=.01). They were also more likely to accept four more quitting preparation sessions (intent to treat, 50.8% vs 29.2%, respectively p<.001) but were not more likely to call a telephone tobacco quit line (intent to treat, 9.3% vs. 5.8%, respectively p=.45). Conclusion/Importance Brief motivational interventions increased engagement in cessation treatment and abstinence among smokers with signification mental illness.

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Section: Discussionmentioning

confidence: 99%

Helping Smokers with Severe Mental Illness Who Do Not Want to Quit

Christiansen

Carbin

TerBeek

et al. 2017

Substance Use & Misuse

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“…Even though the number of smokers interested in reduction treatment constituted only about 10% of all those asked about treatment interest in their clinic visits, typically only 5–10% of smokers will accept an offer to enter cessation treatment. 5,8,19,20 Moreover, of those smokers who were willing to reduce and were randomized to receive Motivation phase treatment, a meaningful portion (19%) opted to receive cessation treatment after receiving brief Motivation phase treatment. 3 …”

Section: Discussionmentioning

confidence: 99%

Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation?

Petersen

Mermelstein

Berg

et al. 2017

Preventive Medicine

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Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 based on a chronic care model of tobacco treatment among study eligible primary care patients (N=1579; 58% women, 89% White) presenting for regular health care visits in southern Wisconsin, U.S. Medical assistants, prompted via the electronic health record (EHR), invited smokers (n=10,242) to learn more about treatment options to help them either reduce their smoking or quit. Of those invited to learn more who were then reached by study staff, 10.2% (n = 1046) reported interest in reduction treatment and 24% (n = 2465) reported interest in cessation treatment. Patients who selected and ultimately entered reduction (n=492) versus cessation (n=1087) were more likely to report: older age; a history of anxiety; lower motivation to quit; lower primary dependence motives; more close friends or family who smoke; and a greater interval since their last quit attempt (ps<.05). Results suggest that Motivation phase treatment aimed at smoking reduction may increase the proportion and range of smokers inducted into tobacco treatment.

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“…While several studies [65, 66] and this study report the use of the EMR to identify smokers, there are few studies [19] that use the EMR to actually document the treatment of smoking in accordance with JC standards [38]. While qualitative comments supported the need for improvement in the documentation template, there is motivation for hospital leadership to conduct this programming as meaningful use (the set of standards defined by the Centers for Medicare & Medicaid Services Incentive Programs that governs the use of EMRs) will allow eligible providers and hospitals to earn incentive payments for implementing tobacco cessation strategies [67].…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

et al. 2016

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BackgroundGuided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.MethodsThis pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention.Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.ConclusionsGiven that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation.Trial registrationClinicalTrials.gov, NCT01309217 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.

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Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record

Cited by 38 publications

References 52 publications

Helping Smokers with Severe Mental Illness Who Do Not Want to Quit

Helping Smokers with Severe Mental Illness Who Do Not Want to Quit

Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation?

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

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