Smoking Cessation Research in Primary Care Treatment Centers: The SCRIPT-MS Project

doi:10.1097/00000441-200310000-00017

The American Journal of the Medical Sciences

Volume 326, Issue 4, October 2003, Pages 238-241

https://doi.org/10.1097/00000441-200310000-00017 Get rights and content

ABSTRACT

Despite wide distribution of an evidence-based clinical practice guideline, the provision of treatment for tobacco use has been weak. The primary care setting is an ideal environment in which to implement the tobacco clinical practice guideline. It has been suggested that implementation of the guideline may be enhanced by adapting guideline recommendations into a stepped-care plus treatment-matching model; however, this model has yet to be tested. This article describes an ongoing investigation designed to evaluate (1) the feasibility of implementing this treatment model in a primary care environment, (2) efforts on identifying reasonable assessment methods, (3) primary care providers’ use of assessment data, and (4) the relationships between predictors and outcomes under differing treatment “step” conditions in primary care settings. Six primary care clinics are participating in this study comparing usual care, brief clinical intervention, and enhanced clinical intervention conditions. The last of these conditions is hypothesized to produce the best and most cost-effective outcomes. Recruitment is expected to continue until January 2004, being 65% complete as of this writing. Follow-up contacts will continue until April 2005. Results should provide information that will contribute to the ongoing development of primary care-based tobacco intervention approaches.

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Acknowledgment

We thank the Mississippi Primary Health Care Association and, in particular, the Executive Directors and staff of the 6 participating clinics, and the SCRIPT-MS staff, whose efforts made this project possible.

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Cited by (8)

Improving tobacco dependence treatment outcomes for smokers of lower socioeconomic status: A randomized clinical trial
2017, Drug and Alcohol Dependence
Citation Excerpt :
A socioeconomically, racially, and ethnically diverse sample was sought to enable socioeconomic comparisons and support external validity. The StdT was a well-established, multi-component, manual-driven cognitive-behavioral EBT for tobacco dependence with 6 weekly 1-h group sessions used in numerous programs and studies (Schmitz et al., 1993; Smith et al., 2003; Payne et al., 2006; Sheffer et al., 2009, 2012a,b, 2013; Varghese et al., 2014). StdT components included understanding and applying the cue-urge-smoking cycle, developing individualized strategies for managing cues and urges, self-monitoring, guided scheduled rate reduction, goal setting, stress management, problem-solving, conflict management, tobacco refusal training, relapse prevention, enhancing social support, and education about medication and the health effects of tobacco.
Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-behavioral treatment for tobacco dependence for diverse lower socioeconomic smokers.
Participants were randomized to adapted or standard treatment, received six 1-h group treatment sessions, and were followed for six months. We examined the effectiveness of the adapted treatment to improve treatment outcomes for lower socioeconomic groups.
Participants (n = 227) were ethnically, racially, and socioeconomically diverse. The adapted treatment significantly reduced the days to relapse for the two lowest socioeconomic groups: SES1: M = 76.6 (SD 72.9) vs. 38.3 (SD 60.1) days to relapse (RR = 0.63 95% CI, 0.45, 0.88, p = 0.0013); SES2: M = 88.2 (SD 67.3) vs. 40.1 (SD 62.6 days to relapse (RR = 0.57 95% CI, 0.18, 0.70, p = 0.0024). Interactions between socioeconomic status and condition were significant for initial abstinence (OR = 1.26, 95% CI 1.09, 1.46, p = 0.002), approached significance for 3-month abstinence (OR = 0.90, 95% CI 0.80, 1.01, p < 0.071), and were not significant for 6-month abstinence (OR = 0.99 95% CI 0.88, 1.10, p = 0.795). No significant differences in long-term abstinence were observed.
Systematic adaption of evidence-based treatment for tobacco dependence can significantly improve initial and short-term treatment outcomes for diverse lower socioeconomic smokers and reduce inequities in days to relapse. Novel methods of providing targeted extended support are needed to improve long-term outcomes.
Smoking-related attitudes and clinical practices of medical personnel in Minnesota
2004, American Journal of Preventive Medicine
Citation Excerpt :
Improving adherence to clinic-based smoking-cessation guidelines is complex and requires a multifaceted effort.29 System-level changes must be appropriate to the individual practice.22,25,30–33 Smoking-cessation interventions are more likely to be incorporated into patient visits when practitioners consider counseling and service delivery relevant and advantageous to their practice.34–36
Effective clinic-based, smoking-cessation activities are not widely implemented.
To compare and contrast the smoking-cessation attitudes and clinical practices of five types of primary healthcare team members.
From July to October 2002, a cross-sectional survey was mailed to randomly selected primary care physicians (MDs), advanced practice nurses (APRNs), registered nurses (RNs), licensed practical nurses (LPNs), and medical assistants (MAs).
Factors associated with limited smoking-cessation service delivery.
The overall response rate was 68% (n =3021). Most respondents reported that patients' smoking status was consistently documented at their clinic (79%); other system prompts were less common (30%). Many respondents reported documenting smoking status or recommending quitting; few reported consistently assessing, assisting, or arranging follow-up. The mean rank of smoking cessation as an important preventive service among nine preventive services declined from MDs (1.9) to APRNs (2.5), RNs (3.4), LPNs (4.2), and MAs (4.6). Smoking prevalence increased from 1% in MDs to 3% APRNs, 9% RNs, 17% LPNs, and 22% MAs. Those who reported no consistent smoking-cessation service delivery were more likely to be RNs, LPNs, or MAs, currently smoke, and work more hours. They were less likely to consider patients receptive to cessation messages, to consider themselves qualified to counsel on smoking, or to work in clinics that had smoking-cessation guidelines or system prompts such as chart reminders.
Smoking-cessation service delivery may be enhanced if educational offerings, system changes, and training include all clinical staff members.
Strategies to improve smoking cessation rates in primary care
2021, Cochrane Database of Systematic Reviews
The efficacy of stepped care models involving psychosocial treatment of alcohol use disorders and nicotine dependence: A systematic review of the literature
2012, Current Drug Abuse Reviews
Offer of a weight management program to overweight and obese weight-concerned smokers improves tobacco dependence treatment outcomes
2011, American Journal on Addictions
Treatment for tobacco dependence for rural, lower-income smokers: Outcomes, predictors, and measurement considerations
2009, American Journal of Health Promotion

View all citing articles on Scopus

: This work was supported in part by a grant from The Partnership for a Healthy Mississippi to the University of Mississippi Medical Center.

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Tobacco Update: Scientific Advances, Clinical PerspectivesSmoking Cessation Research in Primary Care Treatment Centers: The SCRIPT-MS Project

ABSTRACT

Section snippets

Acknowledgment

Prev Med

Mayo Clin Proc

J Am Dent

Am J Prev Med

Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995-1999

MMWR Morb Mortal Wkly Rep

Priority areas for national action: transforming health care quality. Institute of Medicine.

Organizing care for patients with chronic illness

Milbank Q

Does the chronic care model serve also as a template for improving prevention?

Milbank Q

Smoking cessation: clinical practice guideline No. 18

Smoking cessation: what have we learned over the past decade?

J Consult Clin Psychol

Tobacco Update: Scientific Advances, Clinical Perspectives
Smoking Cessation Research in Primary Care Treatment Centers: The SCRIPT-MS Project