Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: a randomized, controlled trial.

BACKGROUND The Agency for Healthcare Research and Quality (AHRQ) Smoking Cessation Clinical Practice Guideline recommends that all clinicians strongly advise their patients who use tobacco to quit. METHODS We conducted a randomized, controlled trial of the effectiveness of Guideline implementation at eight community-based primary care clinics in southern Wisconsin (four test sites, four control sites) among 2163 consecutively enrolled adult patients who smoked at least one cigarette per day and presented for nonemergency care during the baseline period (June 16, 1999, to June 20, 2000) or the intervention period (from June 21, 2000, to May 3, 2001). After collecting baseline data, staff at test sites implemented the intervention over a 2-month period. The intervention included a tutorial for intake clinicians, group and individual performance feedback for intake clinicians, use of a modified vital signs stamp, an offer of free nicotine replacement therapy, and proactive telephone counseling. Staff at control sites received only general information about the AHRQ Guideline. Self-reported abstinence from smoking was determined by telephone interviews at 2- and 6-month follow-up assessments. Hierarchical logistic regression models were used to estimate the odds ratios (ORs) for treatment assignment after adjustment for patient characteristics. All statistical tests were two-sided. RESULTS There were no statistically significant differences in smoking cessation rates between participants at test and control sites during the baseline period. Among participants treated during the intervention period, those at test sites were more likely than those at control sites to report being abstinent at the 2-month (16.4% versus 5.8%; adjusted OR = 3.3, 95% confidence interval [CI] = 1.9 to 5.6; P<.001) and 6-month (15.4% versus 9.8%; adjusted OR = 1.7, 95% CI = 1.2 to 2.6; P =.009) follow-up assessments and to report continuous abstinence, that is, abstinence at both 2 and 6 months (10.9% versus 3.8%; adjusted OR = 3.4, 95% CI = 1.8 to 6.3; P<.001). CONCLUSION Implementation of a guideline-based smoking cessation intervention by intake clinicians in primary care is associated with higher abstinence among smokers.

[1]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[2]  Robert S. Barcikowski,et al.  Statistical Power with Group Mean as the Unit of Analysis , 1981 .

[3]  W. Carter,et al.  Implementing preventive care in clinical practice. II. Problems for managers, clinicians and patients. , 1981, Medical care review.

[4]  M. Demak,et al.  Prevention and health promotion in primary care: baseline results on physicians from the INSURE Project on Lifecycle Preventive Health Services. , 1984, Preventive medicine.

[5]  L. George,et al.  Health promotion in primary care: a survey of U.S. family practitioners. , 1985, Preventive medicine.

[6]  E. Wynder,et al.  Determinants of quitting smoking. , 1987, American journal of public health.

[7]  Development and operation of the Wisconsin Research Network. , 1991, Wisconsin medical journal.

[8]  N Hymowitz,et al.  Baseline factors associated with smoking cessation and relapse. MRFIT Research Group. , 1991, Preventive medicine.

[9]  J. Prochaska,et al.  In Search of How People Change: Applications to Addictive Behaviors , 1992, The American psychologist.

[10]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[11]  W F Velicer,et al.  Assessing outcome in smoking cessation studies. , 1992, Psychological bulletin.

[12]  J. Connett,et al.  Error in smoking measures: effects of intervention on relations of cotinine and carbon monoxide to self-reported smoking. The Lung Health Study Research Group. , 1993, American journal of public health.

[13]  D. C. J. D. D. R. C. R. Wilbanks.  Physician and other health-care professional counseling of smokers to quit--United States, 1991. , 1993, MMWR. Morbidity and mortality weekly report.

[14]  K C Stange,et al.  Competing demands of primary care: a model for the delivery of clinical preventive services. , 1994, The Journal of family practice.

[15]  S S Smith,et al.  Predicting smoking cessation. Who will quit with and without the nicotine patch. , 1994, JAMA.

[16]  M. Fiore,et al.  Smoking status as the new vital sign: effect on assessment and intervention in patients who smoke. , 1995, Mayo Clinic proceedings.

[17]  Health promotion in primary care , 1996, BMJ.

[18]  M. Balabanis,et al.  Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. , 1996, Journal of consulting and clinical psychology.

[19]  Brian T. Austin,et al.  Organizing care for patients with chronic illness. , 1996, The Milbank quarterly.

[20]  T. Coleman,et al.  Anti-smoking advice in general practice consultations: general practitioners' attitudes, reported practice and perceived problems. , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[21]  K. Stange,et al.  Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice. , 1997, The Journal of family practice.

[22]  V. Hasselblad,et al.  Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. , 1997, JAMA.

[23]  L. Solberg,et al.  Smoking screening and management in primary care practices. , 1997, Archives of family medicine.

[24]  T. Perneger,et al.  Collecting saliva samples by mail. , 1998, American journal of epidemiology.

[25]  J. Roski.  Changing practice patterns as a result of implementing the Agency for Health Care Policy and Research guideline in 20 primary care clinics , 1998, Tobacco control.

[26]  Building effective strategies to decrease tobacco use in a health maintenance organisation: Group Health Cooperative of Puget Sound , 1998 .

[27]  R. Grol,et al.  Implementing guidelines and innovations in general practice: which interventions are effective? , 1998, The British journal of general practice : the journal of the Royal College of General Practitioners.

[28]  Siep Thomas,et al.  Attributes of clinical guidelines that influence use of guidelines in general practice: observational study , 1998, BMJ.

[29]  V. Entwistle,et al.  Developing Information Materials to Present the Findings of Technology Assessments to Consumers: The Experience of the NHS Centre for Reviews and Dissemination , 1998, International Journal of Technology Assessment in Health Care.

[30]  S. Flocke,et al.  Opportunistic preventive services delivery. Are time limitations and patient satisfaction barriers? , 1998, The Journal of family practice.

[31]  S. Curry.  Building effective strategies to decrease tobacco use in a health maintenance organisation: Group Health Cooperative of Puget Sound , 1998, Tobacco control.

[32]  D. Singer,et al.  National patterns in the treatment of smokers by physicians. , 1998, JAMA.

[33]  L. Grothaus,et al.  Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. , 1998, The New England journal of medicine.

[34]  M. Fiore,et al.  The Agency for Health Care Policy and Research smoking cessation clinical practice guideline: basics and beyond. , 1999, Primary care.

[35]  E. Yano,et al.  Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. , 1999, Medical care.

[36]  P. McGinn.  Missed opportunities. , 2000, Hospitals & health networks.

[37]  L. Solberg,et al.  Improving prevention systems in primary care practices: the Health Education and Research Trial (HEART) , 2000, The Journal of family practice.

[38]  T. Perneger,et al.  Saliva cotinine levels in smokers and nonsmokers. , 2000, American journal of epidemiology.

[39]  L. Pol,et al.  Tailoring tobacco counseling to the competing demands in the clinical encounter. , 2001, The Journal of family practice.

[40]  C. T. Orleans,et al.  Does the chronic care model serve also as a template for improving prevention? , 2001, The Milbank quarterly.

[41]  M. Goolsby,et al.  Treating Tobacco Use and Dependence , 2008, Pediatrics.

[42]  M. Tingen,et al.  Provider feedback improves adherence with AHCPR Smoking Cessation Guideline. , 2001, Preventive medicine.

[43]  J. E. Anderson,et al.  Strike while the iron is hot: can stepped-care treatments resurrect relapsing smokers? , 2001, Journal of consulting and clinical psychology.

[44]  D. Katz,et al.  Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care. , 2002, Preventive medicine.

[45]  How to find and keep topnotch clinical staff. , 2002, Medical economics.

[46]  Shu-Hong Zhu,et al.  Evidence of real-world effectiveness of a telephone quitline for smokers. , 2002, The New England journal of medicine.

[47]  M. Fiore,et al.  Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. , 2002, Chest.

[48]  Expense survey: what it costs to practice today. , 2002, Medical economics.

[49]  N. Davis,et al.  The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO). , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[50]  W. Velicer,et al.  Biochemical verification of tobacco use and cessation. , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[51]  Risto Lehtonen,et al.  Multilevel Statistical Models , 2005 .

[52]  Prevention and Health Promotion , 2005, Journal of Public Health.

[53]  M. Velasquez,et al.  Motivational Interviewing and the Stages of Change , 2005 .

[54]  Bulletin on the Effectiveness of Health Service Interventions for Decision Makers Bulletin on the Effectiveness of Health Service Interventions for Decision Makers Nhs Centre for Reviews and Dissemination , 2022 .