Too few patients who smoke are offered quitting assistance, and only five percent of US smokers trying to quit use both counseling and medication, the recommended cessation treatment. This project seeks to generate a deeper understanding of factors associated with the reach and implementation of BREATHE 2 for adult primary care patients who smoke.
The program is designed to motivate smokers to quit and to help those ready to quit achieve abstinence. The key components of the BREATHE 2 chronic care approach are:
Systematic assessment of smoking status at primary care visits.
Automatic referral of patients who smoke to a centralized care manager who delivers proactive smoking interventions (unless patients opt out)
Coordination of medications and coaching with primary care providers and the state quitline; and screening and referring medically eligible patients who want help quitting to centralized intensive services. The project will examine the reach and implementation of key facets of the program using assessments guided by the RE-AIM planning and evaluation framework and the PRISM approach to assessing intervention-translation context.
Multi-level, multi-method data will be collected to address the following aims to:
Evaluate the reach, representativeness of reach, and maintenance of reach across time in the clinics that will host the project in two healthcare systems.
Gauge intervention fidelity, adaptations, maintenance, correlates, and outcomes across patient groups, personnel, roles, and sites.
Examine the extent to which implementation is associated with the key outcome of public health interest in this project: abstinence from smoking.
Data to support these aims will be collected from electronic health records of patient smoking and smoking-related intervention exposure; patient ratings of satisfaction; front-line clinic staff and clinician surveys, interviews, observation, and performance metrics; in-depth interviews with and direct observation of care managers who will engage smokers and deliver interventions; and semi-structured interviews with clinic- and system-level leaders who influence adoption and implementation decisions.
This project will cut across ecological levels (patient to system) using mixed methods in two separate cohorts. This will advance our understanding of challenges in implementing systematic, cost-efficient efforts to expand the reach, effectiveness, and sustainability of smoking cessation treatment, and thereby reduce morbidity and mortality related to smoking.