Quality improvement, clinician attitudes, and referrals to tobacco treatment counseling programs

The purpose of this dissertation research is to examine relationships between health system processes to facilitate referrals, clinician attitudes and referrals to tobacco dependence treatment (TDT) counseling programs. Participation in behavioral counseling programs increases quit rates, but clinicians rarely refer patients who smoke to counseling programs. Quality improvement initiatives have resulted in innovative system changes intended to improve recruitment of smokers into TDT counseling programs with mixed outcomes. Successful implementation of system changes depends on the extent to which clinicians perceive system changes to be supportive in their practice. This descriptive, correlational, cross-sectional study sampling MDs, ARNPs and PAs practicing in Kentucky aims to a) determine the presence of health system processes to facilitate referrals in their organization and the community b) determine the relationship between the presence of health system processes and rate of referrals to counseling programs; c) determine the extent to which clinicians perceive health system processes as being supportive in their practice; and d) assess clinician attitudes toward the efficacy of behavioral counseling programs, and their attitudes toward tobacco dependence. To control for extraneous variables that may contribute to clinician referrals to TDT programs, a randomized block sampling design was used. Clinicians by county of practice are categorized within tertiles of low, medium, and high adult participation in tobacco cessation programs (per 10,000 smokers). Findings will be available in May 2010. This research will contribute to improving TDT outcomes by identifying clinician attitudinal and motivational factors that impact the success of health system changes.