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Outreach, training, follow-up associated with increased tobacco treatment delivery

Implementation of the Ottawa Model for Smoking Cessation, which includes outreach facilitation, staff training, electronic medical record tools, and audit and feedback, was associated with increased rates of smoking cessation treatment delivery, according to data published in the Annals of Family Medicine.

Further, high quality implementation of the model was associated with increased use of the “3 A’s” — “ask, advise and act” — smoking intervention. In the Ottawa model, asking about a patient’s smoking was the responsibility of the nursing staff or medical assistants. Meanwhile advising and acting were the responsibility of the physician or nurse practitioner.

“Many providers find it challenging to deliver evidence-based cessation treatment in the context of a busy primary care practice,” Sophia Papadakis, PhD, of the University of Ottawa Heart Institute, in Ontario, Canada, and colleagues wrote. “… Despite evidence from multiple well-designed randomized controlled trials, multicomponent interventions have not been generally implemented.”

According to the researchers, the Ottawa Model for Smoking Cessation (OMSC) is a multicomponent intervention initially designed for use in hospitals. However, it is now also used in primary care practices. In addition to the 3 A’s intervention, the model also introduces a series of best practices for delivering tobacco treatment. These include training an outreach facilitator to help introduce and implement the model within the practice, increased clinical staff training, standardized staff and patient tools, real-time prompts within electronic medical records, follow-up support and counseling, and audits and feedback.

To examine the effectiveness of these strategies, the researchers studied a cross-sectional sample of 32 primary care practices in Ontario, representing 481 clinicians and more than 3,500 tobacco users. The researchers examined the sample before the implementation of the OMSC, and then conducted a second cross-sectional sample following implementation. They then used 3-level modeling to examine the main effects and predictors of 3 A’s delivery.

According to the researchers, delivery rates of the 3 A’s intervention increased significantly following implementation of the model and its strategies. Specifically, “ask” delivery increased from 55.3% to 71.3% (P < .001), “advise” increased from 45.5% to 63.6% (P < .001) and “act” increased from 35.4% to 54.4% (P < .001). In addition, the quality of the program implementation and the reason for clinic visit were associated with increased rates of 3 A’s delivery.

“Our analysis found that implementation of the OMSC 10 Best Practices was an important independent predictor of enhanced 3 A’s delivery,” Papadakis and colleagues wrote. “That high quality implementation of the program was associated with higher rates of 3 A’s delivery reinforces the importance of ensuring fidelity to the intervention model. Providers were significantly more likely to address tobacco use during periodic exams, indicating that clinicians may be missing opportunities when patients present for other reasons.” – by Jason Laday

Disclosure: Papadakis reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.