Abstract
We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support—extracted from practices’ electronic health records—and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices’ tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.
Similar content being viewed by others
References
Babb, S., Malarcher, A., Schauer, G., Asman, K., & Jamal, A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. MMWR: Morbidity and Mortality Weekly Report, 65(52), 1457–1464. https://doi.org/10.15585/mmwr.mm6552a1
Cykert, S., DeWalt, D. A., Weiner, B. J., Pignone, M., Fine, J., & Kim, J. I. (2019). A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ’s EvidenceNow initiative. Journal of the American Medical Informatics Association, 26(2), 155–158
Cykert, S., Keyserling, T. C., Pignone, M., DeWalt, D., Weiner, B. J., Trogdon, J. G., & Fine, J. (2020). A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices. Health Services Research, 55(6), 944–953
Jamal, A., Dube, S. R., & King, B. A. (2015). Peer Reveiwed: Tobacco Use Screening and Counseling During Hospital Outpatient Visits Among US Adults, 2005–2010. Preventing Chronic Disease, 12
Jamal, A., Dube, S. R., Malarcher, A. M., Shaw, L., Engstrom, M. C., Centers for Disease, C., & Prevention (2012). Tobacco use screening and counseling during physician office visits among adults—National ambulatory medical care survey and national health interview survey, United States, 2005–2009. MMWR: Morbidity and Mortality Weekly Report, 61(02), 38–45
Jenkins, W. D., Matthews, A. K., Bailey, A., Zahnd, W. E., Watson, K. S., Mueller-Luckey, G., & Patera, J. (2018). Rural areas are disproportionately impacted by smoking and lung cancer. Preventive Medicine Reports, 10, 200–203
Nutting, P. A., Crabtree, B. F., Stewart, E. E., Miller, W. L., Palmer, R. F., Stange, K. C., & Jaén, C. R. (2010). Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home. The Annals of Family Medicine, 8(Suppl 1), S33–S44
Papadakis, S., Cole, A. G., Reid, R. D., Coja, M., Aitken, D., Mullen, K. A., & Pipe, A. L. (2016). Increasing rates of tobacco treatment delivery in primary care practice: evaluation of the Ottawa Model for Smoking Cessation. The Annals of Family Medicine, 14(3), 235–243
Papadakis, S., McDonald, P., Mullen, K. A., Reid, R., Skulsky, K., & Pipe, A. (2010). Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Preventive Medicine, 51(3–4), 199–213
Persell, S. D., Liss, D. T., Walunas, T. L., Ciolino, J. D., Ahmad, F. S., Brown, T., & Lindau, S. T. (2019). Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial. Medical Care
Shafer, P. R., Borsky, A., Ngo-Metzger, Q., Miller, T., & Meyers, D. (2019). The practice gap: National estimates of screening and counseling for alcohol, tobacco, and obesity. The Annals of Family Medicine, 17(2), 161–163
Shelley, D. R., Gepts, T., Siman, N., Nguyen, A. M., Cleland, C., Cuthel, A. M., & Wu, W. (2020). Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation. American Journal of Preventive Medicine
Stead, L. F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J., & Lancaster, T. (2013). Physician advice for smoking cessation. Cochrane Database Syst Rev, 2013(5), Cd000165. https://doi.org/10.1002/14651858.CD000165.pub4
Tobacco Use and Dependence Guideline Panel (2008). Treating tobacco use and dependence: 2008 update. Rockville, MD: US Department of Health and Human Services. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK63952/. Accessed December 10, 2021
U.S. Department of Health and Human Services (2020). Smoking cessation: A report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA
Weiner, B. J., Pignone, M. P., DuBard, C. A., Lefebvre, A., Suttie, J. L., Freburger, J. K., & Cykert, S. (2015). Advancing heart health in North Carolina primary care: the Heart Health NOW study protocol. Implementation science, 10(1), 160
Funding
Support: This research is supported by the Agency for Healthcare Research & Quality (1R18HS023912).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare they have no conflicts of interest.
Prior Presentation of This Material
We presented a poster of results at the 2021 meeting for the Society for Research on Nicotine and Tobacco.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kowitt, S.D., Goldstein, A.O. & Cykert, S. A Heart Healthy Intervention Improved Tobacco Screening Rates and Cessation Support in Primary Care Practices. J Primary Prevent 43, 375–386 (2022). https://doi.org/10.1007/s10935-022-00672-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10935-022-00672-5