Elsevier

Preventive Medicine

Volume 33, Issue 5, November 2001, Pages 415-421
Preventive Medicine

Regular Article
Provider Feedback Improves Adherence with AHCPR Smoking Cessation Guideline

https://doi.org/10.1006/pmed.2001.0907Get rights and content

Abstract

Background. This study evaluated the effect of primary care providers' adherence with the AHCPR Smoking Cessation Guideline after receiving a multicomponent intervention.

Methods. A quasi-experimental study with one intervention and one control team was conducted in a southeastern Veterans Affairs Medical Center primary care setting. During phase I, chart reviews were conducted to measure baseline provider adherence and documentation of the four A's (ask, advise, assist, arrange). In phase II, the intervention team received a single educational session on the AHCPR Guideline, four A's, and tobacco dependence treatment. This was followed by chart reviews of patients seen 4 to 8 weeks after the educational intervention to measure provider adherence and documentation of the four A's. During phase III, the intervention team received individual and team feedback from the chart reviews in phases I and II and booster education on the AHCPR Guideline. Chart reviews were conducted from patient visits 4 to 8 weeks after the feedback and booster education to determine provider adherence and documentation of the four A's.

Results. A nested repeated measures two-factor analysis of variance was performed for each of the following outcomes: ask, advise, assist, and arrange. Data analyses revealed that both the control and the intervention teams had 100% compliance in asking the patient about smoking status. There was a prestudy implementation of the vital sign stamp that included smoking status in this setting. Education on tobacco dependence and the AHCPR Guideline had no significant impact on provider performance with the advisement, assistance, and arrangement of follow-up. However, significant improvements occurred in the intervention team in the advisement (P = 0.05), assistance (P = 0.001), and arrangement of follow-up (P = 0.001) phase after individual and team feedback was provided. This research supports the fact that feedback impacts individuals and team performances and facilitated positive system changes to improve provider adherence with the AHCPR recommendations in treating tobacco dependence.

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      The guideline recommends five specific components of brief tobacco interventions by providers: Ask, Advise, Assess, Assist, and Arrange (the 5A's). Although these components are efficacious,1,2 it has proved difficult to implement the guidelines in actual clinical practice, as there are several barriers to provider intervention, including a lack of time, expertise, incentives, and a belief that interventions will not be effective.3–6 This has increased interest in utilizing resources such as quitlines as referral sources to remove some of these barriers.7

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    This research project was supported by the Nurses Organization of Veterans Affairs (NOVA) Foundation.

    2

    To whom reprint requests should be addressed. Fax: (706) 721-1498. E-mail: [email protected].

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