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. 2002 Dec;11(4):329–335. doi: 10.1136/tc.11.4.329

Dissemination of the AHCPR clinical practice guideline in community health centres

J DePue 1, M Goldstein 1, A Schilling 1, P Reiss 1, G Papandonatos 1, C Sciamanna 1, A Kazura 1
PMCID: PMC1747684  PMID: 12432158

Abstract

Objective: To evaluate dissemination of the Agency for Health Care Policy and Research (AHCPR) Smoking cessation clinical practice guideline in community health centres.

Design: Pre- and post-trial.

Setting: Fourteen community health centres in Rhode Island.

Subjects: Provider performance was assessed with 1798 and 1591 patient contacts, in pre-post cross sectional consecutive samples, respectively, and 891 contacts at one year follow up.

Interventions: Three, one hour on-site provider training sessions, on review of effective tobacco interventions, use of office systems, and tobacco counselling skill building.

Outcome measures: Chart documentation of four A's (Ask, Advise, Assist, and Arrange follow up) at most recent primary care visit.

Results: While average performance rates increased for Ask and Advise (from 30% to 44%, and 19% to 26%, pre-post, respectively), significant increases were found only for some visit types, with further differences by patient sex. There were significant increases for Ask for all except obstetric/gynaecological (ob/gyn) visit types. Patients at yearly physicals and first visits were more likely to be asked at all time points, while males were more likely to be asked at acute visits than were females. There were no significant increases for Advise, Assist, and Arrange across time, although female patients showed a differential increase in Advise post-training. Advise was significantly more likely in yearly physicals and first visits, and less likely in ob/gyn visits, at all time points.

Conclusions: This guideline dissemination effort resulted in quite different provider counselling rates across patient sexes, and visit types. Guideline implementation may require more sustained efforts, with multiple strategies, which are reinforced at higher policy levels, to more fully integrate tobacco interventions into routine primary care practice with all patients who smoke.

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Selected References

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  1. Cabana M. D., Rand C. S., Powe N. R., Wu A. W., Wilson M. H., Abboud P. A., Rubin H. R. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458–1465. doi: 10.1001/jama.282.15.1458. [DOI] [PubMed] [Google Scholar]
  2. Campbell M. K., Mollison J., Grimshaw J. M. Cluster trials in implementation research: estimation of intracluster correlation coefficients and sample size. Stat Med. 2001 Feb 15;20(3):391–399. doi: 10.1002/1097-0258(20010215)20:3<391::aid-sim800>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  3. Centers for Disease Control and Prevention (CDC) Cigarette smoking among adults--United States, 1998. MMWR Morb Mortal Wkly Rep. 2000 Oct 6;49(39):881–884. [PubMed] [Google Scholar]
  4. Chernof B. A., Sherman S. E., Lanto A. B., Lee M. L., Yano E. M., Rubenstein L. V. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999 Aug;37(8):738–747. doi: 10.1097/00005650-199908000-00004. [DOI] [PubMed] [Google Scholar]
  5. Dickey L. L., Gemson D. H., Carney P. Office system interventions supporting primary care-based health behavior change counseling. Am J Prev Med. 1999 Nov;17(4):299–308. doi: 10.1016/s0749-3797(99)00083-5. [DOI] [PubMed] [Google Scholar]
  6. Dijkstra R. F., Braspenning J. C., Uiters E., van Ballegooie E., Grol R. T. Perceived barriers to the implementation of diabetes guidelines in hospitals in The Netherlands. Neth J Med. 2000 Mar;56(3):80–85. doi: 10.1016/s0300-2977(99)00123-0. [DOI] [PubMed] [Google Scholar]
  7. Doescher M. P., Saver B. G. Physicians' advice to quit smoking. The glass remains half empty. J Fam Pract. 2000 Jun;49(6):543–547. [PubMed] [Google Scholar]
  8. Goldstein M. G., DePue J. D., Monroe A. D., Lessne C. W., Rakowski W., Prokhorov A., Niaura R., Dubé C. E. A population-based survey of physician smoking cessation counseling practices. Prev Med. 1998 Sep-Oct;27(5 Pt 1):720–729. doi: 10.1006/pmed.1998.0350. [DOI] [PubMed] [Google Scholar]
  9. Goldstein M. G., Niaura R., Willey-Lessne C., DePue J., Eaton C., Rakowski W., Dubé C. Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med. 1997 Jun 23;157(12):1313–1319. doi: 10.1001/archinte.157.12.1313. [DOI] [PubMed] [Google Scholar]
  10. Hopkins D. P., Briss P. A., Ricard C. J., Husten C. G., Carande-Kulis V. G., Fielding J. E., Alao M. O., McKenna J. W., Sharp D. J., Harris J. R. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med. 2001 Feb;20(2 Suppl):16–66. doi: 10.1016/s0749-3797(00)00297-x. [DOI] [PubMed] [Google Scholar]
  11. Kottke T. E., Battista R. N., DeFriese G. H., Brekke M. L. Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA. 1988 May 20;259(19):2883–2889. doi: 10.1001/jama.259.19.2883. [DOI] [PubMed] [Google Scholar]
  12. Manley M., Epps R. P., Husten C., Glynn T., Shopland D. Clinical interventions in tobacco control. A National Cancer Institute training program for physicians. JAMA. 1991 Dec 11;266(22):3172–3173. [PubMed] [Google Scholar]
  13. McPhee S. J., Detmer W. M. Office-based interventions to improve delivery of cancer prevention services by primary care physicians. Cancer. 1993 Aug 1;72(3 Suppl):1100–1112. doi: 10.1002/1097-0142(19930801)72:3+<1100::aid-cncr2820721327>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  14. Ockene J. K., Kristeller J., Goldberg R., Amick T. L., Pekow P. S., Hosmer D., Quirk M., Kalan K. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial. J Gen Intern Med. 1991 Jan-Feb;6(1):1–8. doi: 10.1007/BF02599381. [DOI] [PubMed] [Google Scholar]
  15. Ockene J. K. Physician-delivered interventions for smoking cessation: strategies for increasing effectiveness. Prev Med. 1987 Sep;16(5):723–737. doi: 10.1016/0091-7435(87)90054-5. [DOI] [PubMed] [Google Scholar]
  16. Solberg L. I., Brekke M. L., Fazio C. J., Fowles J., Jacobsen D. N., Kottke T. E., Mosser G., O'Connor P. J., Ohnsorg K. A., Rolnick S. J. Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000 Apr;26(4):171–188. doi: 10.1016/s1070-3241(00)26013-6. [DOI] [PubMed] [Google Scholar]
  17. Soumerai S. B., Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990 Jan 26;263(4):549–556. [PubMed] [Google Scholar]
  18. Thorndike A. N., Rigotti N. A., Stafford R. S., Singer D. E. National patterns in the treatment of smokers by physicians. JAMA. 1998 Feb 25;279(8):604–608. doi: 10.1001/jama.279.8.604. [DOI] [PubMed] [Google Scholar]
  19. Wechsler H., Levine S., Idelson R. K., Schor E. L., Coakley E. The physician's role in health promotion revisited--a survey of primary care practitioners. N Engl J Med. 1996 Apr 11;334(15):996–998. doi: 10.1056/NEJM199604113341519. [DOI] [PubMed] [Google Scholar]
  20. Williams C. Dissemination of the Agency for Health Care Policy and Research guideline. Tob Control. 1998 Winter;7 (Suppl):S17–S25. doi: 10.1136/tc.7.2008.s17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Young J. M., Ward J. E. Influence of physician and patient gender on provision of smoking cessation advice in general practice. Tob Control. 1998 Winter;7(4):360–363. doi: 10.1136/tc.7.4.360. [DOI] [PMC free article] [PubMed] [Google Scholar]

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