A study published in the May/June issue of Annals of Family Medicine(www.annfammed.org) examined use of the Ottawa Model for Smoking Cessation(ottawamodel.ottawaheart.ca) (OMSC) in primary care practices and found it successful in increasing rates of tobacco cessation treatment delivery. The model was tested in 32 primary care practices in Ontario, Canada, with 481 clinicians and 3,870 patients participating.
The OMSC is a multicomponent knowledge translation intervention that uses the three A's model: Ask (identify smoking status), Advise (counsel patients to quit smoking) and Act (assist with cessation). After implementing the OMSC, researchers found delivery rates of the three A's increased significantly (Ask: from 55 percent to 71 percent; Advise: from 46 percent to 64 percent; Act: from 35 percent to 54 percent).
Not surprisingly, they found that high-quality implementation of the program (i.e., implementing more than eight of 10 OMSC best practices) was associated with the highest rates of delivery of the three A's, reinforcing the importance of ensuring fidelity to the implementation model. Examples of those best practices include developing a clinic tobacco control protocol, training staff and clinicians in the skills needed to execute that protocol, having self-help materials readily available to patients, and leveraging electronic health record or other real-time prompts to inform clinicians of patients' smoking status at each visit.
- A recent Annals of Family Medicine study examined use of the Ottawa Model for Smoking Cessation in primary care practices and found it helped increase rates of tobacco cessation treatment delivery.
- Specifically, implementation of this multicomponent knowledge translation intervention boosted the rate at which primary care clinicians delivered smoking cessation interventions using the three A's: Ask (identify smoking status), Advise (counsel patients to quit smoking) and Act (assist with cessation).
- After implementing the Ottawa model, researchers found delivery rates of the three A's increased significantly (Ask: from 55 percent to 71 percent; Advise: from 46 percent to 64 percent; Act: from 35 percent to 54 percent).
The researchers also found clinicians were significantly more likely to discuss tobacco use during periodic exams, indicating that physicians might be missing opportunities to screen for tobacco use when patients are seen for other reasons.
"The involvement of nonphysician staff in a team approach to smoking cessation as well as use of electronic medical record prompts are two of the intervention strategies that appear to be important," lead study author Sophia Papadakis, Ph.D., a scientist in the prevention and rehabilitation division at Canada's University of Ottawa Heart Institute, told AAFP News.
The authors concluded that this study further supports current evidence that multicomponent tobacco cessation interventions are effective in primary care settings.
About the Ottawa Model
Papadakis said the OMSC is essentially the structured approach the University of Ottawa Heart Institute uses to document the smoking status of all admitted cardiovascular patients and ensure 98 percent of hospitalized patients who smoke receive bedside smoking cessation interventions from staff and followup after they are discharged.
The model was created in the early 2000s and after seeing quick success, it was scaled up to include 21 hospitals in the Ottawa region with funding by the Ontario Ministry of Health. Today, thanks to funding from a variety of sources, the OMSC is being used in 68 hospitals in Ontario.
Adapting the model for use in primary care practices was part of Papadakis' doctoral work from 2009-2010.
"The large reach of primary care with tobacco users and interest from the primary care community in adapting the model sparked my interest in helping with creating a tailored version of the model for primary care," she said.
In 2011, the Ontario Ministry of Health adopted the program into the Smoke Free Ontario Strategy,(www.ontario.ca) and it is currently the sole financial backer of a network of more than 170 family medicine practices delivery the model in Ontario.
Addressing Barriers to Success
Papadakis said her research team spent a great deal of time trying to understand the key barriers physicians face when trying to deliver evidence-based tobacco cessation treatment. These factors included limited time, knowledge, the complexity of the tobacco treatment intervention itself and attitudes about the importance of addressing smoking cessation with patients in clinical practice.
"Time is the first answer we hear in terms of barriers, and this is an important factor," she said. "We have simplified the intervention and provided training on how to intervene effectively with brief amounts of time."
Another key barrier was physicians' lack of confidence in their ability to help patients follow through on cessation efforts. "Many (physicians) have attempted to do so in the past and have either felt awkward or uncomfortable or have not been successful with their patients," Papadakis said.
Finally, she said many clinicians haven't fully grasped the tenacity of nicotine addiction and view tobacco use as a habit or a choice that patients can't quit because they lack motivation or willpower.
AAFP Tobacco Cessation Resources
The AAFP offers family physicians its own tobacco cessation program -- Ask and Act -- which encourages family physicians to ask all patients about tobacco use and then act to help them quit.
In addition, the Academy has combined its tobacco and nicotine cessation resources into a toolkit that provides extensive information and materials for both family physicians and their patients. Among those resources is the Tar Wars education program for fourth- and fifth-grade students, Office Champions project training and resources, the Academy's anti-tobacco and nicotine advocacy efforts and the AAFP's position paper on preventing and treating nicotine dependence and tobacco use.
Importance of Tobacco Cessation Efforts
Papadakis said it's important for family physicians to participate in tobacco cessation efforts with their patients because tobacco use is high on the list of chronic disease risks.
Her research team continues to improve the OMSC intervention program, with current research focusing on new strategies such as provider coaching to help further increase the rates of tobacco treatment delivery by primary care professionals.
An important part of the improvement process is the input of physicians and health care staff, she said. "I think this is part of the success of the model, which has been refined and improved over the years," Papadakis said. "Primary care professionals have been shown to play a large role in motivating quit attempts among patients, making this an ideal setting for addressing tobacco use."
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