Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial

Paula M Wye,Jenny A Bowman,Emily A Stockings,Chris Oldmeadow,John H Wiggers

doi:10.1186/s12888-017-1220-7

Abstract

BackgroundDespite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities.MethodsWe undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the ‘pre’, ‘during’ and ‘post-intervention’ periods.ResultsThe prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14).ConclusionsThis is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines.

Highlights

Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low
Despite clinical practice guidelines [13, 14] recommending the provision of nicotine dependence treatment to patients in mental health treatment settings in developed nations such as the United States, United Kingdom and Australia [13,14,15], the provision of such treatment in psychiatric facilities has been suboptimal, with assessment of nicotine dependence and provision of nicotine replacement therapy (NRT) in inpatient psychiatric facilities occurring rarely (0%–0.5%) [16, 17]
One third of total discharges (n = 1277, 30.6%) were for patients readmitted to the facilities during the study period

Summary

Introduction

Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. While smoking rates and the corresponding burden of premature death and disability have declined in the general population, this has not been observed among persons with a mental disorder [2, 3]. Reported barriers to the provision of such treatment include lack of time and clinician skill and experience, and lack of organisational support, even when comprehensive nicotine dependence treatment guidelines are in place [18]

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