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Burns A, Gutta J, Kooreman H, Spitznagle M, Yeager VA. Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations. Health Care Manage Rev 2023; 48:323-333. [PMID: 37615942 DOI: 10.1097/hmr.0000000000000380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs). PURPOSE The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation. METHODOLOGY This study used qualitative interviews ( n = 25) to identify themes related to implementing TTSs as a health systems change innovation and examined these themes within the constructs of the theory of innovation implementation. RESULTS Insights about implementing TTSs as an innovation primarily aligned with four theoretical constructs: implementation policies and practices, implementation climate, innovation-values fit, and implementation effectiveness. Specific themes were perceived to facilitate the sustainability of TTSs including team-based TTS efforts, widespread awareness of TTS roles, leadership buy-in, and recognized value of TTS services. Barriers to sustainability included inadequate resources (e.g., time and staff), lack of tracking outcomes, inappropriate referrals, and lack of reimbursement. PRACTICE IMPLICATIONS Health care organizations planning to implement health systems change for tobacco cessation can encourage committed use of TTSs as an innovation by considering the insights provided in this study. These primarily related to five overarching implementation considerations: staff selection and training, tracking and dissemination of impacts, adequate resources, referrals and workflow, and billing and reimbursement.
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Siddiqi AD, Britton M, Chen TA, Carter BJ, Wang C, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9647. [PMID: 35955001 PMCID: PMC9367734 DOI: 10.3390/ijerph19159647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 05/11/2023]
Abstract
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers' perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients' interest in quitting and providers' potential impacts on a successful quit attempt.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Carol Wang
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
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Hilts KE, Yeager VA, Kooreman H, Smith R, Busching B, Spitznagle M. Public Health and Health Care Partnerships for Improved Tobacco Cessation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E404-E412. [PMID: 34347652 PMCID: PMC8807793 DOI: 10.1097/phh.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance. PROGRAM This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation. IMPLEMENTATION Participating organizations' initiatives targeted 3 focus areas: implementing best practices for tobacco cessation; quality improvement; and utilization of the electronic health record. EVALUATION A qualitative study was conducted to examine facilitators and barriers to tobacco cession systems change among participating health care organizations. Common barriers included time constraints, staffing issues, and organizational structure. These factors often differed by organization type (eg, large vs small). Facilitators included leadership buy-in, organizational priority, technical assistance, teams/teamwork, and IT support. DISCUSSION Initial findings suggest that this type of partnership model can be leveraged to gain organizational support, build capacity, address key barriers, and ensure that systems change strategies align with best practices for tobacco cessation across a diverse set of health care organizations. Findings presented in this report provide insights for other public health and health care organizations looking to implement similar initiatives.
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Affiliation(s)
- Katy Ellis Hilts
- Center for Health Policy, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Hilts and Yeager and Mr Kooreman); and Tobacco Prevention and Cessation Commission, Indiana Department of Health, Indianapolis, Indiana (Mss Smith and Spitznagle and Mr Busching)
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Wood W, Jauncey M, Salmon AM, McCrabb S, Bonevski B. Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112050. [PMID: 31185619 PMCID: PMC6603950 DOI: 10.3390/ijerph16112050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 12/02/2022]
Abstract
Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting.
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Affiliation(s)
- Eliza Skelton
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
- Hunter New England Local Health District, Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, NSW 2287, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - William Wood
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Marianne Jauncey
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Allison M Salmon
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
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Ruhil R. Sociodemographic characteristics of tobacco users as determinants of tobacco use screening done by healthcare providers: Global Adult Tobacco Survey India 2009-2010. J Family Med Prim Care 2016; 5:82-8. [PMID: 27453849 PMCID: PMC4943156 DOI: 10.4103/2249-4863.184629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION World Health Organization and Indian Public Health Standards recommend provision of tobacco use screening and cessation help at primary care settings. Evidence shows that brief advice by healthcare provider helps tobacco user quit. It starts with asking the patient about his tobacco use status. The rate of tobacco use screening done by healthcare providers is very low and also depends on sociodemographic characteristics of patients along with several other factors. OBJECTIVES This paper intends to study how sociodemographic characteristics (age, gender, residence [rural/urban], education, and occupation) of tobacco users influence the tobacco use screening done by healthcare providers. MATERIALS AND METHODS The study was a secondary data analysis of the Global Adult Tobacco Survey India 2009-2010. There were 4958 smokers and 7255 smokeless tobacco users included in the study who visited healthcare provider in the past 12 months prior to the survey. RESULTS AND DISCUSSION The results showed that male smokers were more likely to be screened for smoking by healthcare providers as compared to female smokers. Furthermore, tobacco users in younger age groups were less likely to be screened for tobacco use by healthcare providers as compared to tobacco users in older age groups. Urban smokeless tobacco users were more likely to be screened for tobacco use by healthcare provider as compared to rural smokeless tobacco users. CONCLUSION Healthcare providers were being biased in tobacco use screening of their patients based on demographic characteristics of patients, i.e., their age, gender, and rural/urban residence. However, the evidence shows that it is very imperative to screen each and every patient for tobacco use habit.
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Affiliation(s)
- Rohini Ruhil
- Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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