Abstract
BackgroundA systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines. Institutions such as the Veterans Health Administration (VHA) are unique in their systematic approach, but comparisons of provider behavior in different healthcare systems are limited.MethodsWe surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated VHA in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (exposure: AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment (delivery of counseling plus smoking cessation medication or referral) at least once in the past 12 months (composite outcome). Multivariable logistic regression with adjustment for specialty was performed in 2017–2019.ResultsOf 625 healthcare providers surveyed, 407 (65%) responded, and 366 (59%) were analyzed. Most respondents practiced at the AHC (273[75%] vs VHA 93[25%]) and were general internists (215[59%]); pulmonologists (39[11%]); hematologists/oncologists (69[19%]); and gynecologists (43[12%]). Most respondents (328[90%]) reported the primary outcome. The adjusted odds of evidence-based smoking cessation treatment were higher among VHA vs. AHC healthcare providers (aOR = 4.3; 95% CI 1.3–14.4; p = .02). Health systems differed by provision of individual treatment components, including smoking cessation medication use (98% VHA vs. 90% AHC, p = 0.02) and referral to smoking cessation services (91% VHA vs. 65% AHC p = 0.001).ConclusionsVHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers. Healthcare systems’ prioritization of and investment in smoking cessation treatment is critical to improving providers’ adherence to guidelines.
Highlights
A systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines
We found that Veterans Health Administration (VHA) healthcare providers had 4 times the odds of selfreported evidence-based smoking cessation treatment compared to healthcare providers at the academic health center (AHC)
This may be due to the presence of an outpatient-based smoking cessation treatment program at the VHA, which was a main difference between smoking cessation services offered between these healthcare systems
Summary
A systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines. In efforts to improve smoking cessation rates at the population level, the U.S Public Health Service’s Clinical Guideline on Tobacco Use and Dependence recommends a brief intervention using the 5 A’s (Ask, Advise, Assess, Assist, Arrange) for every current smoker at each clinical encounter [5]. This strategy requires all healthcare providers to “Ask” patients their smoking status; “Advise” current smokers to quit; “Assess” smokers’ willingness to quit; “Assist” smokers with cessation; and “Arrange” follow up to re-address smoking cessation efforts [5]. Clinicians report routinely performing “Ask” (87–100%) and “Advise” (66–95%), but far fewer perform the “Assess” (39–85%), “Assist” (16–64%), and “Arrange” (1–23%) steps [7]
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