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Performance coaching for practices increases use of tobacco dependence treatments
Primary care clinicians who utilized performance coaching as part of a multicomponent intervention conduced significantly increased rates of tobacco dependence treatment, according to findings recently published in Annals of Family Medicine.
“The important role of family medicine in addressing tobacco use with patients is well recognized, and multiple international guidelines and reports have identified the need to increase rates of tobacco-dependence treatment in primary care settings,” Sophia Papadakis, PhD, of the division of cardiac prevention and rehabilitation at the University of Ottawa Heart Institute in Canada and colleagues wrote.
Fifteen practices were randomly assigned to participate in either the Ottawa Model for Smoking Cessation or the same model plus a 90-minute skills-based coaching session and an individualized performance report.
According to researchers, the Ottawa Model for Smoking Cessations supports primary care teams by familiarizing them with a team-based, systematic approach to addressing tobacco-dependence treatment delivery based on 10 best practices. Each medical facility received help implementing their assigned model and all were also graded on their rates of delivering the Ask, Advise, Assist, Arrange components of the 5 As tobacco-dependence treatment strategy. Researchers wrote that to reduce the burden on respondents, they did not analyze the Assess component of the 5 As. Four months after the interventions were introduced, researchers found that clinicians in the Ottawa Model for Smoking Cessation plus performance coaching group had statistically greater rates of delivery for Ask (adjusted odds ratio [aOR] = 1.69; 95% CI, 1.05-2.72), Assist (aOR = 1.64; 95% CI, 1.08-2.49), and Arrange (aOR = 2.01; 95% CI, 1.22-3.31). A sensitivity analysis found that the delivery rate for Advise was greater only in those who attended the coaching session (aOR = 1.65; 95% CI, 1.1-2.49). No differences were documented between groups for cessation outcomes.
“Identifying and evaluating simple, effective techniques for promoting tobaccodependence treatment delivery is essential to improving the reach of tobaccodependence treatment interventions in primary care settings. This study lends support for the integration of performance coaching in the design and delivery of multicomponent interventions to further increase rates of tobacco-dependence treatment delivery, particularly among low-performing clinicians,” Papadakis and colleagues concluded. – by Janel Miller
Disclosure: Papadakis reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.
Perspective
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Coaching during cessation can be an effective approach to help smokers quit. As stated in the study, clinician performance coaching, when delivered with a multicomponent intervention such as Ottawa Model for Smoking Cessation, shows great promise in the future of tobacco cessation. A 1.5-hour didactic coaching session, implemented after the Ottawa Model for Smoking Cessation intervention, (done by a trained “coach”) is a great way for clinicians (both physicians and advanced health care providers) to recognize and learn to assess and assist tobacco dependent patients on their journey towards nicotine cessation.
The implementation of an individualized performance report helps the clinicians recognize how they are doing in helping their patients with tobacco cessation.
In my professional opinion, the 5A model — Ask, Advise, Assess, Assist, and Arrange — is very useful in helping to identify patients who are active tobacco users and in assisting with their recovery. It is imperative that the five As be done at every patient encounter — not just annual or well visits. The findings that “performance coaching significantly increased rates of tobacco dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention” are valid, and would benefit a practice.
In actual practice, the clinicians who participated in the Ottawa Model for Smoking Cessation plus performance coaching group would have greater rates of Advise, urging tobacco users to quit, in the intention-to-treat analysis. With that in mind, I was surprised that “no significant difference was observed in the rates of the Advise in the intention-to-treat analysis,” as I would have expected.
There were limitations to the study, which may have influenced the findings. As stated in the article, the authors did suggest a limitation that the “study compared to active-intervention arms and did not include a control condition.” I would argue that a control group should have been added. Another limitation is in regards to the time frame that the authors reported their study on. A time frame of 12 months would be advisable.
I think that the authors should not have assumed “patients lost to follow up were assumed to be active smokers.” There could be other reasons why the patients did not follow up and reaching out to those patients may have been beneficial for the objectives of the study.
After reading this study, I think it would be beneficial to participate in a didactic coaching session along with the Ottawa Model for Smoking Cessation model to help improve the outcome of tobacco cessation in my patients. As a physician, I also would be interested in seeing my personal performance review after this session, being aware and possibly adjusting my practice depending on the results of my review. I am in favor of increasing treatment for tobacco dependence and think each patients’ treatment plan should be individualized.
When assisting patients with cessation, I would advise other health care professionals to follow the 5 As model at every visit and to use the Ottawa Model for Smoking Cessation at every visit. The importance of follow up and arranging for assistance with the patient’s individualized treatment plan is imperative. Giving the patient support and letting them know you are there for them through this journey in a non-judgmental fashion is also important. Providing guidance, continuing with treatment, allowing and recognizing when a patient relapses and not giving up on a patient helps the process.