259018 Changes in patient tobacco use, quit attempts, and perceptions of provider intervention and treatment behavior in a public hospital system

Tuesday, October 30, 2012

Sarah Moody-Thomas, PhD , School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
Tung-Sung Tseng, DrPH , School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
Michael D. Celestin Jr., MA, CHES , School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
Ronald Horswell, PhD , LaCATS Program, Pennington Biomedical Research Center, Baton Rouge, LA
Yong Yi, PhD , Disease Management Program, LSU Health Care Services Division, Baton Rouge, LA
Krysten Jones, MPH, CHES , School of Public Health, Louisiana State University Health Sciences Center, Shreveport, LA
Health systems and clinicians can impact population level cessation rates through application of the US PHS tobacco treatment guideline. However, guideline implementation in primary care settings remains low. This study presents results from an assessment of patient tobacco use, quit attempts, and perceptions of provider treatment before and after guideline implementation in Louisiana's safety-net healthcare system. Using a systems approach, the Tobacco Control Initiative (TCI) integrated evidence-based cessation treatment into care practices in Louisiana's public hospital system. The study included 571 and 889 adult patients selected from primary care clinics in 2004 and 2010, respectively. Chi-square analyses were used to discover differences between administrations, along with direct standardization of weighted rates to control for confounding factors. Smoking every day (42% to 54%) and some days (8% to 13%) increased. Quit attempts also increased (49% to 60%), along with awareness of assistance to quit (19% to 70%). Rates of quitting cold turkey remained relatively similar (75% to 76%), while use of cessation medication decreased (23% to 5%). Provider 5A performance increased (Ask 86% to 90%; Assess 39% to 72%; Assist 24% to 76%; Arrange 8% to 31%), except for advising (86%) smokers to quit, which remained the same. Although patients reported increased tobacco use, awareness of cessation services, quit attempts and receipt of provider 5A intervention increased. This study demonstrates, when integrated into a safety-net healthcare delivery system, comprehensive, multi-level cessation initiatives can produce changes in patient behavior and perceptions of provider engagement.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
Assess the impact of health systems change on patient smoking and cessation behavior, and perceptions of cessation treatment, after US PHS tobacco use guideline integration

Keywords: Patient Perspective, Smoking Cessation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the program manager of several contracts focusing on the epidemiology of tobacco use and dependence. My scientific interests have included the design, implementation and evaluation of evidence-based tobacco prevention and cessation services using systems approaches.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.