Increasing Rates of Tobacco Treatment Delivery in Primary Care Practice: Evaluation of the Ottawa Model for Smoking Cessation

Abstract

Purpose: We report on the effectiveness of the Ottawa Model for Smoking Cessation (OMSC), a multicomponent knowledge translation intervention, in increasing the rate at which primary care providers delivered smoking cessation interventions using the 3 A's model-Ask, Advise, and Act, and examine clinic-, provider-and patient-level determinants of 3 A's delivery.

Methods: We examined the effect of the knowledge translation intervention in 32 primary care practices in Ontario, Canada, by assessing a cross-sectional sample of patients before the implementation of the OMSC and a second cross-sectional sample following implementation. We used 3-level modeling (clinic, clinician, patient) to examine the main effects and predictors of 3 A's delivery.

Results: Four hundred eighty-one primary care clinicians and more than 3,500 tobacco users contributed data to the evaluation. Rates of delivery of the 3 A's increased significantly following program implementation (Ask: 55.3% vs 71.3%, P <.001; Advise: 45.5% vs 63.6%, P <.001; Act: 35.4% vs 54.4%, P <.001). The adjusted odds ratios (AOR) for the delivery of 3 A's between the pre- and post-assessments were AOR = 1.94; (95% CI, 1.61-2.34) for Ask, AOR = 1.92; (95% CI, 1.60-2.29) for Advise, and AOR = 2.03; (95% CI, 1.71-2.42) for Act. The quality of program implementation and the reason for clinic visit were associated with increased rates of 3 A's delivery.

Conclusions: Implementation of the OMSC was associated with increased rates of smoking cessation treatment delivery. High quality implementation of the OMSC program was associated with increased rates of 3 A's delivery.

Keywords: evidence-based practice; health services research; knowledge translation; primary care; smoking cessation.

© 2016 Annals of Family Medicine, Inc.

Figures

Figure 1

Flow of practices and patients through the study.

Figure 2

Clinic performance in the 3 A’s delivery before and after OMSC knowledge translation intervention. AOR = adjusted odds ratio; OMSC = Ottawa Model for Smoking Cessation; 3 A’s = Ask, Advise, Act. Note: The AORs presented control for clinic- and provider-level variance between clusters, availability of cost-free nicotine replacement therapy, gender of the patient, self-reported time of first cigarette, and purpose of visit; based on inclusion of 32 clinics and 481 providers. P values are based on the Wald statistic.