Using a chronic care model improves smoking cessation programs in primary care clinics
Research Activities, July 2009, No. 347
Getting people to quit smoking can be difficult. Primary care providers often use a "5A" approach (ask, advise, assess, assist, and arrange) to help their patients quit the habit. A new study shows that using a chronic care model (CCM) helps providers be more consistent in their adherence to using the 5A approach with patients. Dorothy Y. Hung, Ph.D., M.A., M.P.H., of Columbia University, and Donna R. Shelley, M.D., M.P.H., of New York University, collected data from nearly 500 primary care providers working in 60 community clinics in New York City that served mostly low-income, minority populations.
The researchers looked at the associations between providers delivering 5A services, the clinic's implementation of CCM elements used to treat smoking, and the degree to which these elements were integrated into the clinic's overall operations. The CCM, composed of six elements, is commonly used to improve the care of patients with chronic illnesses such as diabetes, congestive heart failure, and asthma.
Nearly 58 percent of clinic providers asked patients about tobacco use regardless of their history, and nearly 84 percent of them asked patients with a known history of smoking about tobacco use. Providers most likely to perform all 5A services worked in clinics with three CCM elements: enhanced delivery system design, clinical information systems, and the availability of patient self-management support for smoking cessation. However, all six CCM elements, including protocols for tobacco use identification and treatment, decision support such as clinical guidelines, and referral to community resources, were positively and significantly related to provider delivery of 5A services across practices. Providers working in clinics with the highest degree of CCM integration (5 and 6 elements) were 20.4 to 30.9 times more likely to deliver the full spectrum of 5A services to patients. The study was supported in part by the Agency for Healthcare Research and Quality (HS17007).
See "Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care clinics," by Drs. Hung and Shelley, in the February 2009 HSR: Health Services Research 44(1), pp. 103-127.