Abstract
BACKGROUND: Tobacco treatment is underused in primary care. We designed a Tobacco Care Management system to increase the delivery of treatment and reduce the burden on primary care providers (PCPs). A one-click functionality added to the electronic health record (EHR) allowed PCPs to refer smokers to a centralized tobacco treatment coordinator (TTC) who called smokers, provided brief counseling, connected them to ongoing treatment and gave feedback to PCPs. OBJECTIVE: To study the system’s feasibility and acceptability among PCPs, and its utilization by smokers. DESIGN: Using a mixed methods design, we documented system utilization quantitatively from February 1, 2010 to July 31, 2011, and conducted two focus groups with PCPs in June 2011. PARTICIPANTS: Thirty-six PCPs and 2,894 smokers from two community health centers in Massachusetts. MAIN MEASURES: Quantitative: One-click referral utilization by PCPs, proportion of smokers referred and connected to treatment. Qualitative: PCPs’ reasons for use, barriers to use, and experiences with feedback. KEY RESULTS: Twenty-nine PCPs (81 %) used the functionality more than once, generating 466 referrals for 15 % of known smokers seen during the study. The TTC reached 260 (56 %) of the referrals and connected 135 (29 %) to additional treatment. The director of one center sent PCPs monthly feedback about their utilization compared to peers. These PCPs referred a greater proportion of their known smokers (18 % vs. 9 %, p<0.0001) and reported that monthly feedback motivated referrals. PCPs attending focus groups (n= 24) appreciated the system’s simplicity, access to updated resources, and time-efficient way to address smoking, and wanted more feedback about cessation outcomes. They collectively supported the system’s continuation. CONCLUSIONS: A novel EHR-based Tobacco Care Management system was adopted by PCPs, especially those receiving performance feedback, and connected one-third of referred smokers to treatment. The model has the potential to improve the delivery and outcomes of evidence-based tobacco treatment in primary care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1690-1696 |
| Number of pages | 7 |
| Journal | Journal of general internal medicine |
| Volume | 27 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 2012 |
Funding
Partners Healthcare, Inc. funded the Tobacco Care Management program and supported the Tobacco Care coordinator. Dr. Kruse’s effort was supported by grant #T32HP12706-03-00 from the Health Resources and Services Administration for the Harvard General Medicine Fellowship. Dr. Rigotti’s effort was supported by NIH grant #K24-HL08880. The funders of these grants had no role in study design, conduct, data analysis, interpretation, or manuscript preparation, review, or approval. We are grateful for the participation of the Community Health Centers, and wish to thank Southern Jamaica Plain Health Center, Charlestown Health Center, Michael Lambert, MD, and Mark Eisenberg, MD. We would also like to acknowledge Elizabeth Mort, MD, MPH and Partners HealthCare System?s High Performance Medicine for support of the project. Partners Healthcare, Inc. funded the Tobacco Care Management program and supported the Tobacco Care coordinator. Dr. Kruse?s effort was supported by grant #T32HP12706-03-00 from the Health Resources and Services Administration for the Harvard General Medicine Fellowship. Dr. Rigotti?s effort was supported by NIH grant #K24-HL08880. The funders of these grants had no role in study design, conduct, data analysis, interpretation, or manuscript preparation, review, or approval. An earlier version of this information was accepted for presentation as a poster at the Society for Research in Nicotine and Tobacco 18th Annual Meeting, Houston, Texas, March 15, 2012 and the Society for General Internal Medicine 35th Annual Meeting, Orlando, Florida May 12, 2012.
Keywords
- Care management
- Primary care
- Smoking cessation
- Technology assessment
ASJC Scopus subject areas
- Internal Medicine