Great American Smokeout: Addressing Tobacco Cessation in Primary Care
By Beth Sommers, MPH, and Steven Brantley, MPH, Practice Enhancement Research Coordinators at the Oregon Rural Practice-based Research Network.
In honor of the annual November 17th Great American Smokeout, we checked in with two Healthy Hearts Northwest Oregon-based practice coaches to learn about the on-the-ground changes their clinics are making with smoking cessation.
Family Medical Group Northeast
"One of the independent, physician-owned practices I work with in the Portland-metro area has been focusing on identifying patients who use tobacco products and assessing their readiness to quit. Family Medical Group Northeast developed a structured form, called the Tobacco-Free Readiness Assessment (TFRA), to gather patient details around tobacco use and patients' interest in becoming tobacco-free as a means to target cessation conversations and intervention activities based on patients' self-identified stage of change readiness.
The TFRA gathers information from patients on their perceived barriers and motivations to becoming tobacco-free, gauges their awareness of resources available to help them quit, and asks whether patients are interested in receiving active support in becoming tobacco-free.
After administering the TFRA, dummy ICD-10 codes were used to enter these data into the clinic’s electronic medical record (EMR) so that they could measure their progress. Family Medical Group Northeast created data sets to enable tracking of individual and population changes over time. They became interested in following patients who’ve quit using tobacco so they also assigned a dummy code to the “I have quit” stage. Additionally, they created codes to delineate non-tobacco users and to chart when the TFRA is administered. The TFRA data displays in the clinic’s EMR health maintenance section.
I want to show you, step-by-step, the changes we implemented and what the outcomes have been. Here are our six month results:
- Change implemented: Piloted use of the form with two clinicians on one care team.
- Findings: Patients were open and interested in using the form. Information from the form led to deeper, tailored conversations between clinicians and patients.
- Change implemented: Reviewed the form with their patient-advisory council (PFAC) for feedback and suggestions.
- Findings: The PFAC liked that the form was a single page. Liked barriers section on form – will give clinician insight into how to help patient. Confirmed concept and suggested delivery may be better at front desk.
- Change implemented: Tested mechanisms of delivery to patients.
- Findings: Handing it out at the front desk increases form completion rate. Handing the form out during the rooming process did not ensure patients would have enough time to complete it prior to meeting with the provider.
- Change implemented: Held all-staff meetings to share progress and gain clinician and staff input.
- Findings: At a recent meeting the MAs reviewed the form and suggested the dummy codes associated with the stages of readiness be removed from the document. They felt it would make their patients afraid of “Being tracked.” They put the codes in a drop down the file the Medical Assistant can pull in at the point of contact.
- Change implemented: Fully implemented a Tobacco-Free Readiness Assessment workflow across the practice.
- Findings: The tracking portion using the dummy codes went live two weeks ago. They are working on inputting the data they had been tracking in a spreadsheet into the EMR as structured data using the new dummy codes. They will be sharing their first report with me in a week or so.
I’m so proud of the progress Family Medical Group East has made in such a short time!"
– Beth Sommers
Cascades East Family Medicine
"One of the primary care clinics I work with in southern Oregon, Cascades East Family Medicine in Klamath Falls, has taken a slightly different approach with smoking cessation. To get started, clinical champions researched the epidemiology and impact of tobacco use in their population, city, county, and state, and presented their findings to the entire staff. They created a 10-question survey to assess staff interest in quality improvement, retention of tobacco information, and to collect ideas to improve their smoking cessation campaign.
The Cascades East QI team was already a champion at screening: they were monitoring about 99% of their patients for tobacco use. Their opportunity was to increase their rate of counselling to patients, either via the physician or medical assistant. They worked with their IT department to develop an EMR baseline performance measure and began tracking the percentage of patients that screened positive for tobacco use and that were offered counseling. After three months, this counseling metric increased from 12% to 70%.
After another two months and a steady increase in counseling offerings, Cascades East dedicated members of the QI team to continue reporting on tobacco cessation activities. While the team as a whole moved on to other issues as their primary focus, smoking cessation is discussed it at every QI meeting. They’re constantly developing new ideas to address the remainder of their care gap. Smoking cessation is just one piece in the overall structure of our Healthy Hearts NW initiative but supporting people to quit smoking can have an enormous, lasting impact. It’s a privilege to work with a team that’s doing such great work for the people in their communities."
- Download the Family Medical Group Northeast Tobacco Free Readiness Assessment (TFRA)
- Download the Cascades East Family Medicine staff survey
- Contact Beth Sommers or Steven Brantley about their smoking cessation work
Beth Sommers MPH is a Practice Enhancement Research Coordinator at the Oregon Rural Practice-based Research Network (ORPRN) and a Healthy Hearts Northwest practice coach. Her interests include social determinants of health, health policy, primary care transformation, and quality improvement. Beth received her master's degree in public health from Portland State University, and her bachelor's degree in physical anthropology from Oregon State University.
Steven Brantley, MPH is a Practice Enhancement Research Coordinator at the Oregon Rural Practice-based Research Network (ORPRN) and a Healthy Hearts Northwest practice coach. His interests include the spatial relationship of health determinants, primary care transformation, and improving access to healthcare. Steven received his master's degree in public health and his bachelor's degrees in biochemistry and Spanish from Oregon State University