Tobacco use disorder treatment in primary care: implementing a clinical system pathway in Alberta.
Can Fam Physician
; 60(7): 646-55, 2014 Jul.
Article
em En
| MEDLINE
| ID: mdl-25022640
ABSTRACT
OBJECTIVE:
To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians.DESIGN:
A prospective cohort study.SETTING:
Sixty primary care sites in Alberta.PARTICIPANTS:
A convenience sample of 198 primary care physicians from the population of 2857. MAIN OUTCOMEMEASURES:
Data collection occurred between September 2010 and February 2012 on 3 distinct measures. Twenty-four weeks after the intervention, audits of the primary care practices assessed the adoption and sustainability of 10 tobacco clinical system pathway components, a survey measured changes in physicians' treatment intentions, and patient chart reviews examined changes in physicians' consistency with the treatment algorithm.RESULTS:
The completion rate by physicians was 89.4%. An intention-to-treat approach was undertaken for statistical analysis. Intervention uptake was demonstrated by positive changes at 4 weeks in how many of the 10 clinical system measures were performed (mean [SD] = 4.22 [1.60] vs 8.57 [1.46]; P < .001). Physicians demonstrated significant favourable changes in 9 of the 12 measures of treatment intention (P < .05). The 18 282 chart reviews documented significant increases in 6 of the 8 algorithm components.CONCLUSION:
Our findings suggest that the provision of a tobacco clinical system pathway that incorporates other members of the health care team and builds on existing office infrastructures will support positive and sustainable changes in tobacco use disorder treatment by physicians in primary care. This study reaffirms the substantive and important role of supporting how treatment is delivered in physicians' practices.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Tabagismo
/
Padrões de Prática Médica
/
Procedimentos Clínicos
Tipo de estudo:
Guideline
/
Observational_studies
/
Prognostic_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Can Fam Physician
Ano de publicação:
2014
Tipo de documento:
Article