Dissemination of the AHCPR clinical practice guideline in community health centres

• Published in: Tobacco control Vol. 11; no. 4; pp. 329 - 335
• Main Authors: DePue, J D, Goldstein, M G, Schilling, A, Reiss, P, Papandonatos, G, Sciamanna, C, Kazura, A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-12-2002; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Agency for Health Care Policy and Research; AHCPR; American Stop Smoking Intervention Study for Cancer Prevention; Appointments and Schedules; ASSIST; cessation; CEU; Charts; Clinical medicine; CME; Community health; Community Health Centers; Community health services; confidence interval; continuing education units; continuing medical education; Counseling; Documentation; Evaluation; Feedback; Female; guidelines; Health care policy; Health facilities; Health policy; Humans; ICC; Intervention; intraclass correlation coefficient; JCAHO; Joint Commission on Accreditation of Healthcare Organizations; Low income groups; Male; Medical practice; Medical referrals; Methods; Nurses; ob/gyn; obstetric/gynaecological; Odds Ratio; Patient education; physician counselling; Physicians; Planning; Practice; Practice Guidelines as Topic; Primary care; Primary health care; Problem solving; Prognosis; Program Evaluation; Psychoeducational intervention; Public health; Recommendations; Regression analysis; Research Paper; Rhode Island; Rhode Island Department of Health; RIDOH; Smoking Cessation; Smoking cessation programs; Tobacco; Training; Vital signs; Rhode Island; United States > US
• ISSN: 0964-4563; 1468-3318
• DOI: 10.1136/tc.11.4.329

Objective: To evaluate dissemination of the Agency for Health Care Policy and Research (AHCPR) Smoking cessation clinical practice guideline in community health centres. Design: Pre- and post-trial. Setting: Fourteen community health centres in Rhode Island. Subjects: Provider performance was assessed with 1798 and 1591 patient contacts, in pre-post cross sectional consecutive samples, respectively, and 891 contacts at one year follow up. Interventions: Three, one hour on-site provider training sessions, on review of effective tobacco interventions, use of office systems, and tobacco counselling skill building. Outcome measures: Chart documentation of four A’s (Ask, Advise, Assist, and Arrange follow up) at most recent primary care visit. Results: While average performance rates increased for Ask and Advise (from 30% to 44%, and 19% to 26%, pre-post, respectively), significant increases were found only for some visit types, with further differences by patient sex. There were significant increases for Ask for all except obstetric/gynaecological (ob/gyn) visit types. Patients at yearly physicals and first visits were more likely to be asked at all time points, while males were more likely to be asked at acute visits than were females. There were no significant increases for Advise, Assist, and Arrange across time, although female patients showed a differential increase in Advise post-training. Advise was significantly more likely in yearly physicals and first visits, and less likely in ob/gyn visits, at all time points. Conclusions: This guideline dissemination effort resulted in quite different provider counselling rates across patient sexes, and visit types. Guideline implementation may require more sustained efforts, with multiple strategies, which are reinforced at higher policy levels, to more fully integrate tobacco interventions into routine primary care practice with all patients who smoke.