Outreach facilitation visits |
A trained outreach facilitator worked with each primary care clinic over a 3-month period to implement the programme. A seven-step facilitation process was used to introduce the OMSC 10 best practices. Facilitators acted by supporting clinics to: review current clinic practices in the delivery of evidence-based smoking-cessation intervention and complete needs assessment; provide information and recommendations on the integration of evidence-based smoking-cessation strategies into clinical practice; facilitate development of a clinic tobacco treatment protocol for integrating evidence-based smoking cessation strategies into all clinic appointments; define roles and responsibilities of clinic staff in delivering evidence-based smoking-cessation treatments; support communications and training activities for members of the clinic staff.
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Training clinic staff |
Frontline physicians and nurse practitioners participated in a 3-hour training session that provided information and skills training in addressing tobacco use with patients in the context of a busy primary care practice setting. Key staff who would be responsible for delivering quit plan visits (eg, nurse, nurse practitioner or pharmacist) attended an intensive 1-day training session that taught them how to conduct the quit plan and follow-up visits based on evidence-based practice.
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Standardised provider and patient tools | All materials were designed to support intervention delivery and reduce the amount of face-to-face time required to support tobacco treatment delivery. These included:Patient Tobacco Use Survey to document smoking history. Checklist style Smoking Cessation Consult Form. Patient Quit Plan booklet for Smokers Ready to Quit. Booklet for Smokers Not Ready to Quit. Clinic waiting room posters and materials.
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Real-time prompts and electronic medical record tools |
Real-time point-of-care reminders (eg, standard smoking status questions) were introduced and embedded in vital sign screening forms and prompts to deliver brief advice. Standardised forms embedded into electronic medical records to guide tobacco treatment delivery for advice, quit plan and follow-up visit.
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Adjunct follow-up support and counselling | Patient’s ready to quit could be referred to the telephone-based Smoker’s Follow-up System, which included five triage calls over a 2-month period delivered by Interactive Voice Response System. Patients struggling with their quit attempt received additional telephone-based support from trained smoking-cessation counsellors. |
Coaching and feedback session | A supplemental 1.5-hour group-based coaching session was delivered approximately 4 weeks following the launch of the OMSC at their clinic. This was facilitated by a trained tobacco treatment specialist using a standardised facilitation guide. The performance coaching session was designed to increase provider self-efficacy in tobacco treatment delivery, identify personal barriers to tobacco treatment delivery and exchange experiences in addressing these barriers. |