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Meredith LR, Hurley B, Friedman TC, Lee ML, Rodriguez L, Lopez B, Mtume N, Dixon T, Belani HK, Hsieh S, Ray LA. Implementation of Specialty Tobacco Use Disorder Services in a Community Health Setting: Support for Enhanced Prescription Practices. J Addict Med 2023; 17:677-684. [PMID: 37934530 DOI: 10.1097/adm.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Although public efforts to reduce tobacco use have been successful, millions of US adults currently smoke tobacco. Reducing the public health burden of tobacco use disorder (TUD) and eliminating disparities experienced by underresourced communities requires increased accessibility to services. The goal of this study was to assess whether prescriptions for evidence-based medications for tobacco treatment showed steeper growth rates among community health clinics providing specialty TUD services as compared with treatment as usual. METHODS Clinic-wide data on prescriptions for smoking cessation pharmacotherapy at 18 primary care or mental health community clinics operated by Los Angeles County were retrieved for 4 years of an ongoing implementation trial. Specialty services included behavioral counseling and medications for tobacco treatment. Descriptive statistics characterized prescriptions rates across clinics and time. Analyses compared the slopes of the changes between intervention groups across time for primary care and mental health sites. RESULTS Within primary care clinics, the most commonly prescribed smoking cessation medications were nicotine patches, nicotine gum, and varenicline. Throughout the trial, all clinics displayed increased rates of prescribing smoking cessation medications. Analytic results supported overall steeper increases in prescription rates for these medications among clinics randomized to specialty services versus treatment as usual within primary care ( P = 0.020) and mental health sites ( P = 0.004). CONCLUSIONS This work provides support for the effectiveness of community-based implementation interventions that promote prescribing smoking cessation medications with the potential to reduce health disparities among communities at greater risk for TUD and its consequences.
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Affiliation(s)
- Lindsay R Meredith
- From the Department of Psychology, University of California, Los Angeles, Los Angeles, CA (LRM, LAR); Los Angeles County Department of Public Health, Los Angeles, CA (BH); Friends Research Institute, Cerritos, CA (BH, TCF, LR, BL, NM, TD); Los Angeles County Department of Health Services, Los Angeles, CA (TCF, HKB, SH); Department of Internal Medicine, Charles R. Drew University, Los Angeles, CA (TCF, MLL); Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA (MLL); Brain Research Institute, University of California, Los Angeles, Los Angeles, CA (LAR); and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA (LAR)
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Yang MJ, Martínez Ú, Fulton HJ, Maconi ML, Turner K, Powell ST, Chern JY, Brandon TH, Vidrine JI, Simmons VN. Qualitative evaluation of the implementation and future sustainability of an e-referral system for smoking cessation at a US NCI-designated comprehensive cancer center: lessons learned. Support Care Cancer 2023; 31:483. [PMID: 37480364 PMCID: PMC10577649 DOI: 10.1007/s00520-023-07956-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Promoting smoking cessation is recognized as an essential part of cancer care. Moffitt Cancer Center, supported by the National Cancer Institute Cancer Moonshot Cancer Center Cessation Initiative, developed and implemented an opt-out-based automatic electronic health record (EHR)-mediated referral (e-referral) system for Tobacco Quitline services along with options for local group cessation support and an in-house tobacco treatment specialist. This study evaluated barriers and facilitators for implementation of the e-referral system. METHOD Steering committee members (N=12) responsible for developing and implementing the new clinical workflow and nurses (N=12) who were expected to use the new e-referral system completed semi-structured interviews. Qualitative thematic content analyses were conducted. RESULTS Interviewees perceived the e-referral system as an effective strategy for identifying and referring smokers to cessation services. However, barriers were noted including competing demands and perceptions that smoking cessation was a low priority and that some patients were likely to have low motivation to quit smoking. Suggestions to improve future implementation and sustainability included providing regular trainings and e-referral outcome reports and increasing the visibility of the e-referral system within the EHR. CONCLUSION Initial implementation of the e-referral system was perceived as successful; however, additional implementation strategies are needed to ensure sustainability at both the clinician and system levels. Recommendations for future modifications include providing regular clinician trainings and developing a fully closed-loop system. Implications for cancer survivors Initial implementation of an e-referral system for smoking cessation for cancer patients revealed opportunities to improve the smoking cessation referral process at cancer centers.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
| | - Úrsula Martínez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Hayden J Fulton
- Participant Research, Intervention, and Measurements Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Melinda Leigh Maconi
- Participant Research, Intervention, and Measurements Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Sean T Powell
- Social Work and Patient Support Services, Moffitt Cancer Center, Tampa, FL, USA
| | - Jing-Yi Chern
- Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Kruk A, Czerwińska C, Dolna-Michno J, Broniatowska E, Kolanko E. Effectiveness of a Smoking Cessation Program during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:1536. [PMID: 37297676 PMCID: PMC10252602 DOI: 10.3390/healthcare11111536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
The coronavirus disease-2019 pandemic has caused major obstacles for effective smoking cessation programs by significantly limiting access to healthcare. This cross-sectional analysis aimed to assess the effectiveness of a self-developed smoking cessation program during the pandemic. The program was based on remote lectures, educational interventions, and hybrid services provided by an outpatient clinic. We assessed 337 participants enrolled to the program between January 2019 and February 2022. Data on demographic characteristics, medical history, and smoking status at baseline and after at least 1-year follow-up were collected from medical records and a standardized self-developed questionnaire. Participants were classified into two groups according to their current smoking status. The smoking cessation rate at 1 year was 37% (95% confidence interval [CI]: 31-42%). Major predictors of smoking cessation were the place of residence, ability to refrain from smoking during severe illness, and the number of cigarettes smoked per day. The proportion of participants with high levels of nicotine dependence at baseline was 40.8% (95% CI: 34.5-47.5%) vs. 29.1% (95% CI: 23.4-35.5%) after the program. In the group that did not quit smoking, there were more participants who smoked within 5 min after waking up than before the program (40.4% [95% CI: 34.0-47.1%] vs. 25.4% [95% CI: 19.9-31.6%]). Effective smoking cessation interventions can be performed using remote counseling and education.
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Affiliation(s)
- Aleksandra Kruk
- Department of Pulmonology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Celina Czerwińska
- Department of Pulmonology, John Paul II Hospital, 31-202 Kraków, Poland
| | | | - Elżbieta Broniatowska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland
| | - Emanuel Kolanko
- Department of Pulmonology, John Paul II Hospital, 31-202 Kraków, Poland
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Presant CA, Ashing K, Raz D, Yeung S, Gascon B, Stewart A, Macalintal J, Sandoval A, Ehrunmwunsee L, Phillips T, Salgia R, Merla A, Subbiah S, El-Hajjouie M, Staley J, Graves H, Pathak R, Dingal S, Sampath S, Laksana B, Joseph T, Eugenio T, Degoma V, Burns K, Phillips S, Tan T, Tarkshian K, Sun V, Amini A, Davy K, Cronkhite J, Cianfrocca M, Brown S, Fong Y, Rosen S. Overcoming Barriers to Tobacco Cessation and Lung Cancer Screening among Racial and Ethnic Minority Groups and Underserved Patients in Academic Centers and Community Network Sites: The City of Hope Experience. J Clin Med 2023; 12:1275. [PMID: 36835811 PMCID: PMC9965998 DOI: 10.3390/jcm12041275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Tobacco control is important for cancer patient health, but delivering effective low-dose CT (LDCT) screening and tobacco cessation is more difficult in underserved and patients from racial and ethnic minority groups. At City of Hope (COH), we have developed strategies to overcome barriers to the delivery of LDCT and tobacco cessation. METHODS We performed a needs assessment. New tobacco control program services were implemented focusing on patients from racial and ethnic minority groups. Innovations included Whole Person Care with motivational counseling, placing clinician and nurse champions at points of care, training module and leadership newsletters, and a patient-centric personalized medicine Personalized Pathways to Success (PPS) program. RESULTS Emphasis on patients from racial and ethnic minority groups was implemented by training cessation personnel and lung cancer control champions. LDCT increased. Tobacco use assessment increased and abstinence was 27.2%. The PPS pilot program achieved 47% engagement in cessation, with self-reported abstinence at 3 months of 38%, with both results slightly higher in patients from racial and ethnic minority groups than in Caucasian patients. CONCLUSIONS Tobacco cessation barrier-focused innovations can result in increased lung cancer screening and tobacco cessation reach and effectiveness, especially among patients from racial and ethnic minority groups. The PPS program is promising as a personalized medicine patient-centric approach to cessation and lung cancer screening.
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Affiliation(s)
- Cary A. Presant
- City of Hope Medical Center, 1500 East Duarte Rd, Duarte, CA 91010, USA
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Barrington-Trimis JL, Klemperer EM, Majmundar A, Harrell M. The Impact of the COVID-19 Pandemic on Nicotine Use: What Have We Learned? Nicotine Tob Res 2023; 25:175-176. [PMID: 36478086 PMCID: PMC10465091 DOI: 10.1093/ntr/ntac265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elias M Klemperer
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Anuja Majmundar
- Tobacco Control Research, American Cancer Society Inc., Atlanta, GA, USA
| | - Melissa Harrell
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
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