Abstract
BackgroundAlthough dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence.Methods/DesignGuided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines—staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers’ tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence.DiscussionWe hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices.Trial registrationNCT01615237.
Highlights
Dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence
Evaluation plan The evaluation plan is intended to compare the effectiveness of three promising strategies for implementation of the tobacco use treatment guidelines, to examine multilevel, theory-driven mechanisms hypothesized to explain the effectiveness of the three strategies for implementation, and to identify multi-level barriers and facilitators that that may influence the implementation of evidence-based tobacco use treatment practices in dental care settings
Outcome evaluation Primary outcome To assess the primary outcome of provider adherence to tobacco use treatment guidelines, we will conduct and compare pre- and post-intervention patient exit interviews conducted with eligible smokers at each of the 18 clinic sites
Summary
Dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Citing persistent missed opportunities to promote tobacco cessation, the Institute of Medicine’s (IOM) report [5], ‘Ending the Tobacco Problem: A Blueprint for the Nation,’ called for greater efforts to implement effective tobacco cessation interventions in healthcare settings. These recent health policy reports highlight the need and potential public health value of reducing health disparities through dissemination of evidence-based tobacco cessation interventions in healthcare delivery systems serving low-income and other highrisk smokers [5,6]. The potential impact of implementing tobacco clinical practice guidelines in these public health dental clinics is substantial [9]
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