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Tildy BE, McNeill A, Perman-Howe PR, Brose LS. Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies. BMC Prim Care 2023; 24:32. [PMID: 36698052 PMCID: PMC9875430 DOI: 10.1186/s12875-023-01981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Internationally, there is an 'evidence-practice gap' in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the 'real-world'. AIM To identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness. METHODS 'Embase', 'Medline', 'PsycINFO', 'CINAHL', 'Global Health', 'Social Policy & Practice', 'ASSIA Applied Social Sciences Index and Abstracts' databases, and grey literature sources were searched from inception to April 2021. Studies were included if they evaluated an implementation strategy implemented on a nation-/state-wide scale, targeting any type of healthcare professional within the primary care setting, aiming to increase smoking cessation treatment provision. PRIMARY OUTCOME MEASURES implementation strategy identification, and effectiveness (practitioner-/patient-level). SECONDARY OUTCOME MEASURES perceived facilitators and barriers to effectiveness, and cost-effectiveness. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the Expert Recommendations for Implementing Change (ERIC) compilation and the Consolidated Framework for Implementation Research (CFIR). RESULTS Of 49 included papers, half were of moderate/low risk of bias. The implementation strategy domains identified involved utilizing financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three increased practitioner-level smoking status recording and cessation advice provision. Interventions in the utilizing financial strategies domain also appeared to increase smoking cessation (patient-level). Key facilitator: external policies/incentives (tobacco control measures and funding for public health and cessation clinics). Key barriers: time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about available cessation support options. No studies assessed cost-effectiveness. CONCLUSIONS Some implementation strategy categories increased the rate of smoking status recording and cessation advice provision in primary care. We found some evidence for interventions utilizing financial strategies having a beneficial impact on cessation. Identified barriers to effectiveness should be reduced. More pragmatic approaches are recommended, such as hybrid effectiveness-implementation designs and utilising Multiphase Optimization Strategy methodology. PROTOCOL REGISTRATION PROSPERO:CRD42021246683.
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Affiliation(s)
- Bernadett E Tildy
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK. .,SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Parvati R Perman-Howe
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Leonie S Brose
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
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Burke LA, Steffen AD, Kataria S, Watson KS, Winn RA, Oyaluade D, Williams B, Duangchan C, Asche C, Matthews AK. Associations in Cigarette Smoking and Health Conditions by Race/Ethnicity Among a Diverse Sample of Patients Receiving Treatment in a Federally Qualified Health Care Setting in Chicago. Health Equity 2023; 7:80-88. [PMID: 36876237 PMCID: PMC9982142 DOI: 10.1089/heq.2022.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose To examine the association of cigarette use and smoking-related health conditions by race/ethnicity among diverse and low-income patients at a federally qualified health center (FQHC). Methods Demographics, smoking status, health conditions, death, and health service use were extracted from electronic medical data for patients seen between September 1, 2018, and August 31, 2020 (n=51,670). Smoking categories included everyday/heavy smoker, someday/light smoker, former smoker, or never smoker. Results Current and former smoking rates were 20.1% and 15.2%, respectively. Males, Black, White, non-partnered, older, and Medicaid/Medicare patients were more likely to smoke. Compared with never smokers, former and heavy smokers had higher odds for all health conditions except respiratory failure, and light smokers had higher odds of asthma, chronic obstructive pulmonary disease, emphysema, and peripheral vascular disease. All smoking categories had more emergency department visits and hospitalizations than never smokers. The associations between smoking status and health conditions differed by race/ethnicity. White patients who smoked had a greater increase in odds of stroke and other cardiovascular diseases compared with Hispanic and Black patients. Black patients who smoked had a greater increase in odds of emphysema and respiratory failure compared with Hispanic patients. Black and Hispanic patients who smoked had a greater increase in emergency care use compared with White patients. Conclusion Smoking was associated with disease burden and emergency care and differed by race/ethnicity. Health Equity Implications Resources to document smoking status and offer cessation services should be increased in FQHCs to promote health equity for lower income populations.
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Affiliation(s)
- Larisa A Burke
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sandeep Kataria
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Karriem S Watson
- Office of Director, All of Us Research Program, National Institute of Health, Bethesda, Maryland, USA
| | | | - Damilola Oyaluade
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Barbara Williams
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Cherdsak Duangchan
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Carl Asche
- University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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O'Cleirigh C, King D, Stanton AM, Goldin A, Kirakosian N, Crane HM, Grasso C. Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center. J Community Health 2021; 47:1-8. [PMID: 34215994 DOI: 10.1007/s10900-021-01015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/16/2022]
Abstract
Tobacco use remains the leading cause of preventable disease and death in the US. The number of tobacco products has grown over the past decade. E-cigarette use has increased rapidly in recent years, but patterns and correlates of use have not been thoroughly assessed. We examined relationships among demographic factors, e-cigarette and conventional cigarette use in a large sample (N = 12,409) of adult patients at a community health center in the Northeastern US. Overall, 13% (N = 1675) of the sample reported ever using e-cigarettes. In logistic regression models, ever having used e-cigarettes was associated with younger age (ages 18-25; OR = 3.5, p < 0.001). Being transgender (OR = 1.8, p < 0.001), bisexual (OR = 1.5, p < 0.001), un-partnered (OR = 1.5, p < 0.001), having a lower income (OR = 1.6, p < 0.001) or a high BMI (OR = 1.4, p = 0.009) were associated with increased odds of use, whereas being a woman (OR = 0.7, p < 0.001) or Black/African American (OR = 0.7, p = 0.007) were associated with lower odds of use. Of the participants who reported e-cigarette use, a majority also endorsed current or former use of conventional cigarettes. Individuals who formerly used conventional cigarettes were nearly three times more likely to report daily e-cigarette use than current users. Among primary care patients at a community health center, e-cigarette use was reported by a sizeable portion of the sample. Overall, odds of use were higher in certain patient populations, and individuals who formally used cigarettes were more likely to report e-cigarette use than individuals who currently smoke, suggesting that e-cigarettes may be functioning as a cessation aid or a strategy to reduce conventional cigarette use.
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Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amanda Goldin
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA
| | - Heidi M Crane
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.,Madison HIV Metabolic Clinic, Harborview Medical Center, Seattle, WA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Lu MT, Raghu VK, Mayrhofer T, Aerts HJWL, Hoffmann U. Deep Learning Using Chest Radiographs to Identify High-Risk Smokers for Lung Cancer Screening Computed Tomography: Development and Validation of a Prediction Model. Ann Intern Med 2020; 173:704-713. [PMID: 32866413 PMCID: PMC9200444 DOI: 10.7326/m20-1868] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lung cancer screening with chest computed tomography (CT) reduces lung cancer death. Centers for Medicare & Medicaid Services (CMS) eligibility criteria for lung cancer screening with CT require detailed smoking information and miss many incident lung cancers. An automated deep-learning approach based on chest radiograph images may identify more smokers at high risk for lung cancer who could benefit from screening with CT. OBJECTIVE To develop and validate a convolutional neural network (CXR-LC) that predicts long-term incident lung cancer using data commonly available in the electronic medical record (EMR) (chest radiograph, age, sex, and whether currently smoking). DESIGN Risk prediction study. SETTING U.S. lung cancer screening trials. PARTICIPANTS The CXR-LC model was developed in the PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial (n = 41 856). The final CXR-LC model was validated in additional PLCO smokers (n = 5615, 12-year follow-up) and NLST (National Lung Screening Trial) heavy smokers (n = 5493, 6-year follow-up). Results are reported for validation data sets only. MEASUREMENTS Up to 12-year lung cancer incidence predicted by CXR-LC. RESULTS The CXR-LC model had better discrimination (area under the receiver-operating characteristic curve [AUC]) for incident lung cancer than CMS eligibility (PLCO AUC, 0.755 vs. 0.634; P < 0.001). The CXR-LC model's performance was similar to that of PLCOM2012, a state-of-the-art risk score with 11 inputs, in both the PLCO data set (CXR-LC AUC of 0.755 vs. PLCOM2012 AUC of 0.751) and the NLST data set (0.659 vs. 0.650). When compared in equal-sized screening populations, CXR-LC was more sensitive than CMS eligibility in the PLCO data set (74.9% vs. 63.8%; P = 0.012) and missed 30.7% fewer incident lung cancers. On decision curve analysis, CXR-LC had higher net benefit than CMS eligibility and similar benefit to PLCOM2012. LIMITATION Validation in lung cancer screening trials and not a clinical setting. CONCLUSION The CXR-LC model identified smokers at high risk for incident lung cancer, beyond CMS eligibility and using information commonly available in the EMR. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Michael T Lu
- Massachusetts General Hospital Cardiovascular Imaging Research Center, Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, and Harvard Medical School, Boston, Massachusetts (M.T.L., V.K.R., U.H.)
| | - Vineet K Raghu
- Massachusetts General Hospital Cardiovascular Imaging Research Center, Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, and Harvard Medical School, Boston, Massachusetts (M.T.L., V.K.R., U.H.)
| | - Thomas Mayrhofer
- Harvard Medical School, Boston, Massachusetts,and Stralsund University of Applied Sciences, Stralsund, Germany (T.M.)
| | - Hugo J W L Aerts
- Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, Massachusetts General Hospital Cardiovascular Imaging Research Center, and Harvard Medical School, Boston, Massachusetts (H.J.A.)
| | - Udo Hoffmann
- Massachusetts General Hospital Cardiovascular Imaging Research Center, Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, and Harvard Medical School, Boston, Massachusetts (M.T.L., V.K.R., U.H.)
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Fortmann SP, Bailey SR, Brooks NB, Hitsman B, Rittner SS, Gillespie SE, Hill CN, Leo MC, Crawford PM, Hu W, King DS, O'Cleirigh C, Puro J, Ann McBurnie M. Trends in smoking documentation rates in safety net clinics. Health Serv Res 2020; 55:170-177. [PMID: 31930738 DOI: 10.1111/1475-6773.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the impact of provider incentive policy on smoking status documentation. DATA SOURCES Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). STUDY DESIGN This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. DATA EXTRACTION METHODS We extracted structured EMR data for patients age 18 and older with at least one primary care visit. PRINCIPAL FINDINGS Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. CONCLUSIONS Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.
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Affiliation(s)
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Neon B Brooks
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Weiming Hu
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Conall O'Cleirigh
- The Fenway Institute, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jon Puro
- Research Informatics and Analytics, OCHIN, Inc., Portland, Oregon
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