Treatment Of Tobacco Addiction Research Articles

The Impact of The COVID-19 Pandemic on Smoking Cessation

Objective: In our study, we aimed to reveal the number of applications made to the smoking cessation clinic in our hospital, smoking cessation behavior, and the relationship between this situation and the status of being diagnosed with COVID-19 in the nine months before and after March 11, 2020, when the first case with a diagnosis of COVID-19 was detected in our country.
 Methods: Individuals over 18 who applied to the Ministry of Health’s Ordu University Training and Research Hospital smoking cessation outpatient clinic within nine months before (Group A) and after the COVID-19 pandemic (Group B) were included in our study. Age, gender, chronic diseases, Fagerström addiction scores, and treatment they received for smoking cessation were noted through the tobacco addiction treatment monitoring system (TÜBATİS), and their smoking status was questioned by reaching them three months after their application to us. In the first year of the pandemic, the patients in Group A were reached again and questioned about whether they had been diagnosed with COVID-19 (PCR positivity).
 Results: It was determined that there were 320 patients in Group A and 60 patients in Group B, and there was a statistically significant difference in age and smoking cessation behavior between the two groups (p < 0.05). While 20.6% of Group A was 55 years old and over and 8.1% was under 25 years old, these rates were 13.3% and 21.7% in Group B, respectively (p = 0.041). The percentage of those who quit smoking was 48.9% in Group A and 30.9% in Group B (p = 0.029). When the patients in Group A were re-evaluated in the first year of the pandemic, the rate of having COVID-19 was 6.6% in those who quit smoking, 6.3% in those who did not quit, and 31.2% in those who quit and started again (p = 0.001).
 Conclusion: Health services have had to give up their workforce to fight the epidemic during the pandemic process, and therefore, there has been a decrease in patient admissions in smoking cessation polyclinics. During the restriction periods, there was an increase in the tendency to smoke due to reasons such as social isolation, increased mental and physical slowdown, psychological effects, and economic concerns, and a decrease in the application to health centers due to the risk of transmission, especially in elderly patients with chronic diseases. We think the decrease in our smoking cessation rates and especially in the applications of patients over 55 years old compared to the pre-pandemic period may be due to this reason. Smoking cessation studies should be carried out more decisively, and information should be provided about the combined risks associated with smoking, even in regular outpatient clinic meetings.

Physical and mental health status of former smokers and non-smokers patients with bipolar disorder.

Up to 70% individuals with bipolar disorder (BD) are lifetime tobacco smokers, a major modifiable risk factor for morbidity. However, quitting smoking is rarely proposed to individuals with BD, mainly because of fear of unfavorable metabolic or psychiatric changes. Evaluating the physical and mental impact of tobacco cessation is primordial. The aim of this study was to characterize the psychiatric and nonpsychiatric correlates of tobacco smoking status (never- vs. current vs. former smokers) in individuals with BD. 3860 individuals with ascertained BD recruited in the network of Fondamental expert centers for BD between 2009 and 2020 were categorized into current, former, and never tobacco smokers. We compared the sociodemographic and clinical characteristics assessed by standard instruments (e.g., BD type, current symptoms load, and non-psychiatric morbidity-including anthropometric and biological data) of the three groups using multinomial regression logistic models. Corrections for multiple testing were applied. Current smokers had higher depression, anxiety, and impulsivity levels than former and never-smokers, and also higher risk of comorbid substance use disorders with a gradient from never to former to current smokers-suggesting shared liability. Current smokers were at higher risk to have a metabolic syndrome than never-smokers, although this was only evidenced in cases, who were not using antipsychotics. Tobacco smoking was associated with high morbidity level. Strikingly, as in the general population, quitting smoking seemed associated with their return to the never-smokers' levels. Our findings strongly highlight the need to spread strategies to treat tobacco addiction in the BD population.

Effect of the COVID-19 pandemic on smoking habits in a tertiary hospital.

The aim of this study was to identify changes in smoking behaviors along with the reasons thereof, 1 year after the pandemic started. Alterations in the smoking behavior of patients were investigated in the study. Patients admitted to our Smoking Cessation Outpatient Clinic between March 1st, 2019, and March 1st, 2020, and registered in the Tobacco Addiction Treatment Monitoring System (TUBATIS) were evaluated. Patients were called in March 2021 by the same physician who conducted the smoking cessation outpatient clinic. When the first year of the pandemic was over, the smoking behavior of 64 (63.4%) patients did not change. Of the 37 patients who changed their smoking behavior, eight (21.6%) increased the amount of tobacco they consumed, twelve (32.5%) decreased the amount of tobacco they consumed, eight (21.6%) quit smoking, and nine (24.3%) relapsed smoking. When the reasons for the changes in smoking behavior were examined 1 year after the pandemic started, it was determined that the primary reason for patients who increased the amount of tobacco they consumed and started smoking again was stress, and the primary cause in those who reduced the number of cigarettes and quit smoking was health concerns due to the pandemic. This result can be a guide for estimating smoking trends in future crises or pandemics and for making necessary plans during the pandemic period to increase the rate of smoking cessation.

The Executive Functioning Paradox in Substance Use Disorders.

Deficits in neurocognitive functioning are trait-like vulnerabilities that have been widely studied in persons with substance use disorders (SUD), but their role in the craving-use association and relapse vulnerability remains poorly understood. The main objectives of this study were to examine whether executive capacities moderate the magnitude of the craving-substance use relationship, and if this influence is correlated with the functional connectivity of cerebral networks, combining rsfMRI examinations and ecological momentary assessment (EMA). Eighty-six patients beginning outpatient treatment for alcohol, tobacco or cannabis addiction and 40 healthy controls completed neuropsychological tests followed by EMA to collect real-time data on craving. Fifty-four patients and 30 healthy controls also completed a resting-state fMRI before the EMA. Among the patients with SUD, better verbal fluency and resistance to interference capacities were associated with a greater propensity to use substances when the individual was experiencing craving. Preliminary rsfMRI results identified specific networks that interacted with executive performance capacities to influence the magnitude of the craving-use association. Individuals with better executive functioning may be more prone to relapse after craving episodes. Specifically, better resistance to interference and cognitive flexibility skills may reduce attention to distracting stimuli, leading to a greater awareness of craving and susceptibility to use substances.

Actualización en tabaquismo, abordaje desde la farmacia comunitaria y tratamientos farmacológicos de elección

Smoking is a chronic addictive disease with a pandemic character and, therefore, requires the development of prevention and treatment strategies. The relationship of smoking with obesity and genetics has been studied in recent years, as well as its approach in adolescents, the main objective of the tobacco industry. The implications of second-hand smoke (passive smoking), third-hand smoke (toxics in the smoker’s environment) and fourth-hand smoke (environmental pollution from tobacco) are well known, as is the fact that there is no safe level of smoking, as numerous studies show. The community pharmacist, due to his basic training and accessibility, is an ideal health professional to act in the prevention of smoking and its treatment, developing a professional smoking service in his pharmacy, for which specific training and a adequate physical structure of the pharmacy are required. The treatment of tobacco addiction must be, fundamentally, a combination of pharmacological treatment with cognitive-behavioral treatment. The drugs of first choice for its treatment are Nicotine Replacement Therapy (NRT) combined (patches together with oral form) and varenicline. The kinetics of nicotine in NRT and its agonist effect on alpha 4 beta 2 receptors and the agonist-antagonist effect of varenicline on them, explain its mechanism of action and effectiveness. Cytisine, an alkaloid from which varenicline is derived, and with a similar mechanism of action, is a drug recently marketed in Spain, although it has been used in eastern countries for many years. It has demonstrated its effectiveness and safety, and with the experience of its use in our setting, it is expected to be included in the first line of pharmacological treatment of smoking.

Understanding the implementation strategy of a secondary care tobacco addiction treatment pathway (the CURE project) in England: a strategic behavioural analysis

ObjectivesThe Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project implemented an evidence-based intervention that offers a combination of pharmacotherapy and behavioural support to tobacco-dependent inpatients. Understanding key characteristics of...

Role of anterior insula cortex in context-induced relapse of nicotine-seeking.

Tobacco use is the leading cause of preventable death worldwide, and relapse during abstinence remains the critical barrier to successful treatment of tobacco addiction. During abstinence, environmental contexts associated with nicotine use can induce craving and contribute to relapse. The insular cortex (IC) is thought to be a critical substrate of nicotine addiction and relapse. However, its specific role in context-induced relapse of nicotine-seeking is not fully known. In this study, we report a novel rodent model of context-induced relapse to nicotine-seeking after punishment-imposed abstinence, which models self-imposed abstinence through increasing negative consequences of excessive drug use. Using the neuronal activity marker Fos we find that the anterior (aIC), but not the middle or posterior IC, shows increased activity during context-induced relapse. Combining Fos with retrograde labeling of aIC inputs, we show projections to aIC from contralateral aIC and basolateral amygdala exhibit increased activity during context-induced relapse. Next, we used fiber photometry in aIC and observed phasic increases in aIC activity around nicotine-seeking responses during self-administration, punishment, and the context-induced relapse tests. Next, we used chemogenetic inhibition in both male and female rats to determine whether activity in aIC is necessary for context-induced relapse. We found that chemogenetic inhibition of aIC decreased context-induced nicotine-seeking after either punishment- or extinction-imposed abstinence. These findings highlight the critical role nicotine-associated contexts play in promoting relapse, and they show that aIC activity is critical for this context-induced relapse following both punishment and extinction-imposed abstinence.

Predictors of Successful Smoking Cesstion in Cardiac Rehabilitation Patients with a History of Acute Coronary Syndrome

Aim: To establish socio-psychological and clinical smoking predictors cessation at the stage of health-resort rehabilitation in patients who have recently suffered an acute coronary event. Materials and Methods: 68 patients aged 42-68 years (average age 56.70}6.1 years) who underwent a cardiorehabilitation program in the heart rehabilitation department of the health-resort complex „Morshinkurort” after a recent ACS (no more than 28 days ago) were examined. Depending on the smoking habit, all patients were divided into two groups. The first (I) group included smoking patients who gave up smoking in the course of CR (n=38, average age 57.10}6.73 years), the second (II) group included smokers who continued smoking during the healthresort stay treatment (n=30, average age 56.58}5.74 years). Predictors of smoking cessation were determined in patients of the studied groups using the method of binary logistic regression. Results: In the course of the study, 5 independent predictors of quitting smoking were established, which turned out to be statistically significant - smoking index, anxiety level, body mass index, comorbidity and marital status. The chances of quitting smoking were 1.79 times greater (95% CI from 1.25 to 2.56) in patients with higher BMI and 3.23 times (95% CI from 0.57 to 18.40) in those who are in family status. High comorbidity, higher SI score, and higher anxiety levels were significantly associated with a reduced likelihood of quitting smoking. Conclusions: Cardiac rehabilitation patients with high nicotine dependence, lower body weight, loneliness, significant anxiety symptoms, and multiple comorbidities are less likely to successfully quit smoking. Established independent predictors of smoking cessation must be used when choosing strategies for the treatment of tobacco addiction at the stage of CR. Screening and treatment for anxiety disorders should be included in smoking cessation programs to improve the SI effectiveness.

Tobacco use and Dependence in Adolescents: A Review

Despite rising acknowledgement of the onset of tobacco smoking in children and adolescents, foundational understanding about many elements of early-life smoking behavior, as well as statistics to advocate for specific treatment approaches among children and adolescents, is inadequate. Nicotine addiction and withdrawal have been linked to continued cigarette use and difficulty stopping. When adolescents first start smoking, few expect to have trouble quitting. However, more than half of smoking teens say they try to quit every year, and fewer than 20% of those who smoke ten or more cigarettes per day say they are successful for even a month. Treatment of tobacco addiction rely mainly on the behavioral interventions as medications safety are not assessed for those less than 18 years old, so more research should be encouraged to find about the safety and availability for alternatives as behavioral intervention is not suitable alone for moderate to severe cases, Tobacco products are used by youth in a variety of ways,When smoking cessation efforts are undertaken in developed and developing nations, the wide diversity of tobacco products must be taken into consideration.
 This research deals with the causes of tobacco dependence among young people, diagnosis and treatment methods.

Health economic analysis for the ‘CURE Project’ pilot: a hospital-based tobacco dependency treatment service in Greater Manchester

IntroductionTreating tobacco dependency in patients admitted to acute care National Health Service (NHS) trusts is a key priority in the NHS 10-year plan. This paper sets out the results of...

Understanding the enablers and barriers to implementing smoke-free NHS sites across acute care trusts in Greater Manchester: results of a hospital staff survey

The current study aims to identify enablers and barriers to implementing smoke-free NHS hospital grounds through a hospital staff survey. Staff members from eight acute care NHS trusts in Greater Manchester were invited to complete a 15-minute web-based questionnaire. Five-hundred and eighty-eight participants completed the questionnaire. Nineteen per cent (114/588) of respondents were current smokers and 10% (61/588) were currently vaping. Sixty per cent (68/114) smoked at work and 66% (40/61) vaped at work. Sixty-seven per cent (314/468) supported dedicated on-site tobacco addiction treatment services for hospital staff with specific support for drop-in clinics and free pharmacotherapy for staff. Sixty-one per cent (290/477) and 67% (318/477) strongly agreed / agreed that patients/visitors and staff, respectively, should not smoke on hospital grounds. Seventeen per cent (83/484) had received training in very brief advice. Thirty-five per cent (190/547) felt vaping was less harmful than smoking, 19% (92/472) felt exhaled vapour was likely to be safe to bystanders, 36% (172/475) would support vaping-friendly hospital grounds and 31% (37/120) felt confident in discussing vaping. Enablers to a smoke-free NHS site include dedicated tobacco addiction services for staff and empowering staff through appropriate training to support smokers on the hospital grounds. Barriers include the lack of awareness and support for the harm reduction benefits of vaping.

Strategies to improve smoking cessation rates in primary care.

Strategies to improve smoking cessation rates in primary care.

Further pharmacological characterization of a preclinical model of the early development of nicotine withdrawal

BackgroundEstablishing preclinical models of the development of nicotine withdrawal following acute nicotine exposure could inform tobacco addiction-related research, treatment, and policy. To this end, this lab has previously reported that rats exhibit withdrawal-like elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior) following acute nicotine exposure. The goal of this study was to provide further pharmacological characterization of ICSS as a measure of spontaneous and antagonist-precipitated withdrawal from acute nicotine. Methods and resultsRats exhibited a small increase in ICSS thresholds over time following a single nicotine injection (1.0 mg/kg, s.c.), suggesting a modest spontaneous withdrawal effect (Experiment 1). In Experiment 2, the antidepressant bupropion (5.0 mg/kg, i.p.), which is used to treat tobacco addiction and attenuates nicotine withdrawal in both humans and rodents, blocked elevations in ICSS thresholds induced by a single injection of nicotine (0.5 mg/kg, s.c.) followed ≈ 2 h later by the non-selective, non-competitive nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (3.0 mg/kg, s.c.). In Experiment 3a, s.c. administration of the competitive, relatively selective α4ß2 nAChR antagonist dihydro-beta-erythroidine (DHßE) (5.6 mg/kg, but not 3.0 mg/kg) following each of 5 daily injections of nicotine (0.5 mg/kg, s.c.) elevated ICSS thresholds. Mecamylamine (3.0 mg/kg, s.c.) also elevated ICSS thresholds when administered following all 5 daily nicotine injections (0.5 mg/kg, s.c., Experiment 3b). ConclusionsThese findings provide further characterization of elevations in ICSS thresholds as a measure of withdrawal from acute nicotine exposure. Further use of these models may be useful for understanding the early development of nicotine withdrawal.

GABAB receptors blockage modulates somatic and aversive manifestations induced by nicotine withdrawal

There is substantial evidence that GABAB agonist, baclofen, prevents somatic and motivational responses induced by nicotine withdrawal and may target drug cue vulnerabilities in humans. In this context, we explored different aspects associated with the possible mechanisms whereby the GABAB receptors might influence nicotine withdrawal. Male mice received nicotine (2.5 mg/kg, s.c.) 4 times daily, for 7 consecutive days. Nicotine-treated mice received the nicotinic acetylcholine receptor antagonist, mecamylamine (MEC, 2 or 3.5 mg/kg, s.c.), to precipitate the withdrawal state. A second group of dependent mice received 2-hydroxysaclofen (GABAB receptor antagonist, 1 mg/kg, s.c.) before MEC-precipitated abstinence. Somatic signs of nicotine withdrawal were measured for 30 min. Anxiogenic-like response associated to nicotine withdrawal was assessed by the elevated plus maze test. The dysphoric/aversive effect induced by nicotine withdrawal was evaluated using conditioned place aversion paradigm. Dopamine, serotonin and its metabolites concentrations were determined by HPLC in the striatum, cortex and hippocampus. Finally, α4β2 nicotinic acetylcholine receptor density was determined in several brain regions using autoradiography assays. The results showed that MEC-precipitated nicotine withdrawal induced somatic manifestations, anxiogenic-like response and dysphoric/aversive effect, and 2-hydroxysaclofen potentiated these behavioral responses. Additionally, 2-hydroxysaclofen was able to change striatal dopamine levels and α4β2 nicotinic acetylcholine receptor density, both altered by MEC-precipitated nicotine withdrawal. These findings provide important contributions to elucidate neurobiological mechanisms implicated in nicotine withdrawal. We suggest that GABAB receptor activity is necessary to control alterations induced by nicotine withdrawal, which supports the idea of targeting GABAB receptors to treat tobacco addiction in humans.

Addressing Smoking Cessation among Women in Substance Use Treatment: A Qualitative Approach to Guiding Tailored Interventions.

Intersecting socially marginalized identities and unique biopsychosocial factors place women with substance use disorders (SUDs) experiencing myriad disadvantages at higher risk for smoking and stigmatization. Here, based on our work with women receiving care for SUDs in four participating treatment/women-serving centers (N = 6 individual clinics), we: (1) describe the functions of smoking for women with SUDs; and (2) explore participants’ experiences of a comprehensive tobacco-free workplace (TFW) program, Taking Texas Tobacco-Free (TTTF), that was implemented during their SUD treatment. Ultimately, information gleaned was intended to inform the development of women-tailored tobacco interventions. Data collection occurred pre- and post-TTTF implementation and entailed conducting client (7) and clinician (5) focus groups. Using thematic analysis, we identified four main themes: “the social context of smoking,” “challenges to finding support and better coping methods,” “addressing underlying conditions: building inner and outer supportive environments,” and “sustaining support: TFW program experiences.” Women reported that: smoking served as a “coping mechanism” for stress and facilitated socialization; stigmatization hindered quitting; non-stigmatizing counseling cessation support provided alternative coping strategies; and, with clinicians, the cessation opportunities TTTF presented are valuable. Clinicians reported organizational support, or lack thereof, and tobacco-related misconceptions as the main facilitator/barriers to treating tobacco addiction. Effective tobacco cessation interventions for women with SUDs should be informed by, and tailored to, their gendered experiences, needs, and recommendations. Participants recommended replacing smoking with healthy stress alleviating strategies; the importance of adopting non-judgmental, supportive, cessation interventions; and the support of TFW programs and nicotine replacement therapy to aid in quitting.

Leczenie uzależnienia od tytoniu – zarys problematyki

Leczenie uzależnienia od tytoniu – zarys problematyki

Integrating a brief alcohol intervention with tobacco addiction treatment in primary care: qualitative study of health care practitioner perceptions

BackgroundRandomized trials of complex interventions are increasingly including qualitative components to further understand factors that contribute to their success. In this paper, we explore the experiences of health care practitioners in a province wide smoking cessation program (the Smoking Treatment for Ontario Patients program) who participated in the COMBAT trial. This trial examined if the addition of an electronic prompt embedded in a Clinical Decision Support System (CDSS)—designed to prompt practitioners to Screen, provide a Brief intervention and Referral to Treatment (SBIRT) to patients who drank alcohol above the amounts recommended by the Canadian Cancer Society guidelines—influenced the proportion of practitioners delivering a brief intervention to their eligible patients. We wanted to understand the factors influencing implementation and acceptability of delivering a brief alcohol intervention for treatment-seeking smokers for health care providers who had access to the CDSS (intervention arm) and those who did not (control arm).MethodsTwenty-three health care practitioners were selected for a qualitative interview using stratified purposeful sampling (12 from the control arm and 11 from the intervention arm). Interviews were 45 to 90 min in length and conducted by phone using an interview guide that was informed by the National Implementation Research Network’s Hexagon tool. Interview recordings were transcribed and coded iteratively between three researchers to achieve consensus on emerging themes. The preliminary coding structure was developed using the National Implementation Research Network’s Hexagon Tool framework and data was analyzed using the framework analysis approach.ResultsSeventy eight percent (18/23) of the health care practitioners interviewed recognized the need to simultaneously address alcohol and tobacco use. Seventy four percent (17/23), were knowledgeable about the evidence of health risks associated with dual alcohol and tobacco use but 57% (13/23) expressed concerns with using the Canadian Cancer Society guidelines to screen for alcohol use. Practitioners acknowledged the value of adding a validated screening tool to the STOP program’s baseline questionnaire (19/23); however, following through with a brief intervention and referral to treatment proved challenging due to lack of training, limited time, and fear of stigmatizing patients. Practitioners in the intervention arm (5/11; 45%) might not follow the recommendations from CDSS if these recommendations are not perceived as beneficial to the patients.ConclusionsThe results of the study show that practitioners’ beliefs were reflective of the current social norms around alcohol use and this influenced their decision to offer a brief alcohol intervention. Future interventions need to emphasize both organizational and sociocultural factors as part of the design. The results of this study point to the need to change social norms regarding alcohol in order to effectively implement interventions that target both alcohol and tobacco use in primary care clinics.Trial registration ClinicalTrials.gov NCT03108144. Retrospectively registered 11 April 2017, https://www.clinicaltrials.gov/ct2/show/NCT03108144

Adapting Evidence-Based Tobacco Addiction Treatment for Inuit Living in Ontario: A Qualitative Study of Collaboration and Co-creation to Move From Pan-Indigenous to Inuit-Specific Programming


 
 
 Settler introduction of tobacco to Inuit Nunangat (homeland of Inuit in Canada) has led to high tobacco use prevalence among Inuit. Inuit are moving from traditional territories to the province of Ontario to access resources, including health services. Indigenous-specific tobacco cessation approaches in Ontario lack cultural relevance among Inuit, as they often reflect First Nations and Métis worldviews. To improve effectiveness of tobacco cessation services for Inuit living in Ontario, materials reflective of Inuit culture and worldviews were developed through a community-based participatory approach. The Centre for Addiction and Mental Health collaborated with Tungasuvvingat Inuit and members of an Engagement Circle who work with Inuit or identify as Inuk (n = 25) to initiate a knowledge translation project aimed at co-creating a toolkit of Inuit-specific cessation resources. Development was guided by Two-Eyed Seeing, whereby Inuit and Western worldviews come together to support a strengths-based approach. The toolkit was evaluated through a pilot session and focus group with Inuit living in Ottawa who use tobacco (n = 13) and an online survey administered with a group of helpers who work with Inuit (n = 11). Analysis of qualitative data from the focus group and online survey highlighted five themes: choice, cultural relevance and safety, capacity-building, access, and impact. Focus group participants reported they learned quitting was possible and identified new strategies to quit through the session. Our findings emphasize the importance of engagement and co-creation with Indigenous Peoples to ensure cultural relevance and appropriateness of healthcare interventions.
 
 

Performance Change in Treating Tobacco Addiction: An Online, Interprofessional, Facilitated Continuing Education Course (TEACH) Evaluation at Moore's Level 5.

Continuing education is essential to build capacity among health care providers (HCPs) to treat people with tobacco addiction. Online, interprofessional training programs are valuable; however, interpretation and comparison of outcomes remain challenging because of inconsistent use of evaluation frameworks. In this study, we used level 5 of Moore's evaluation framework to examine whether an online training program in intensive tobacco cessation counseling achieved sustained performance change among HCPs across multiple health disciplines. The evaluation sample included 62 HCPs with direct clinical duties, who completed the online Training Enhancement in Applied Counseling and Health (TEACH) Core Course in 2015 and 2016. We compared self-reported changes in cessation counseling and clinical practices across eight core competencies from baseline to 6-month follow-up using McNemar's tests and descriptive analyses. Compared with baseline, significantly more HCPs reported providing cessation counseling at 6-month follow-up (44% versus 81%, P < .001). HCPs also reported significant increases in engagement in six of the eight core competencies. Online training in intensive tobacco cessation treatment can result in sustained performance improvement at 6 months. However, availability of resources and clinical context may influence the extent to which HCPs are able to implement their learned skills. Furthermore, continuing education programs should consider the use of consistent evaluation frameworks to promote cross program comparisons.

Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative

The goal of the Stanford Tobacco Treatment Initiative was to improve referrals from primary care clinics to a specialty tobacco addiction treatment clinic. Lean A3 problem solving was used to map current state, perform a cause and effect analysis, develop key drivers for program referrals, and ideate tests of change. We discarded ideas that put any additional burden on on-the-ground providers, favouring automated and sustainable processes. After prioritizing for feasibility and impact, plan-do-study-act (PDSA) cycles were performed on the following interventions: education and outreach, referral champions, and automated referrals. Following implementation, referrals to the specialty tobacco treatment clinic increased by 600% and had no impact on clinic provider workflow. The new process spread through all of Stanford Primary Care clinics, has sustained over time, and could serve as a model for other institutions seeking to enhance capacity for tobacco treatment in their health care system using process improvement methodology.