Healthcare provider cessation practices in Ontario. Alexey Babayan Knowledge Exchange Forum June 18, 2014

Transcription

1 Healthcare provider cessation practices in Ontario Alexey Babayan Knowledge Exchange Forum June 18, 2014

2 What we know Tobacco cessation interventions by healthcare providers (physicians, nurses, dental professionals, etc) are effective (Fiore et al., 2008; Gorin&Heck 2004) Many smokers visit a healthcare provider each year (e.g. physician:83%, dentist:70%; CTUMS ) 5A s is a recommended model for tobacco cessation treatment (Fiore et al., 2008)

3 What we learned The potential of health professionals engagement in cessation is far from being realized in Ontario The current incentive system appears to be inadequate for engagement Access to training and cessation resources is likely to improve engagement Practitioner- and organizational-level barriers are critical to engagement Ontario Tobacco Research Unit

4 Current cessation practice in Ontario: Physicians Source: Study of Physicians Uptake of OHIP Billing Codes, OTRU 2011 Method: analysis of administrative data (OHIP) analysis of survey data (CTUMS) interviews with physicians (n=21) Ontario Tobacco Research Unit

5 Uptake of billing codes On average, 5,157 physicians billed for initial discussion at least once per year, ( 50% of physicians in Ontario) The number of patients billed by a physician varies greatly (range: 1 to 1,278 patients per year) 50% of physicians billed for <18 patients Ontario Tobacco Research Unit

6 Billing data vs. population level survey estimates, Ages , 690 smokers received at least one initial cessation discussion (Q041 and E079), Source: Canadian Tobacco Use Monitoring Survey Ontario Health Insurance Plan

7 Patients Billed for Initial and Follow-up Cessation Counseling Source: Ontario Health Insurance Plan

8 Current cessation practice in Ontario: Dental professionals Source: Provision of Smoking Cessation by Ontario Dental Health Professionals, OTRU 2012 Method: Web-based survey of dentists, dental hygienists and dental assistants (n=1966, 9% response rate) Interviews with dental professionals (n=23)

9 Provision of 5 A s by dental professionals, n=1966 (to all or most patients who smoke) Ask Advise Assess Overall, (n=1966), % Dentist (n=217) % Dental Hygienist (n=432) % Dental Assistants (n=1317) % Ask patients about their smoking status b 55.6 c 33.3 Advise patients to stop smoking b 49.7 c 25.8 Assess patients readiness to quit a,b 49.5 c 17.4 Offer self-help resources a 17.9 c 10.2 Assist Recommend NRT a 16.0 c 8.8 Refer to external resources b 18.1 c 8.1 Arrange Arrange follow-up a 9.2 c 4.7 a Significant differences between dentists and dental hygienists, p < 0.05 b Significant differences between dentists and dental assistants, p < 0.05 c Significant differences between dental hygienists and dental assistants, p < 0.05

10 Dental professionals confidence to provide services

11 Current cessation practice in Ontario: Nurses Source: Evaluation of the RNAO Nursing Best Practice Cessation Initiative, OTRU 2013 Method: Baseline and follow-up surveys of nurses (n=400) Case-studies of practice settings (review of documents, interviews) Ontario Tobacco Research Unit

12 RNAO Nursing Best Practice Smoking Cessation Initiative

13 Provision of 5 A s by Nurses, n=400 (to all or most patients who smoke) Ask Advise Assess Ask patients about their smoking status Baseline, % 6-month follow-up, % P <0.001 Advise patients to stop smoking <0.001 Assess patients readiness to quit Offer self-help resources Assist Recommend NRT Refer to external resources Arrange Arrange follow-up

14 Nurses confidence to provide cessation services Baseline, % 6-month follow-up, % Confident <0.001 P Not confident Ontario Tobacco Research Unit

15 KEY FACTORS AFFECTING SERVICE PROVISION Ontario Tobacco Research Unit

16 Key Factors Patient interest in quitting Time Organizational policies/practices Buy-in/support from management Cessation service provision Confidence Training Billing rules Remuneration Awareness and access to cessation services and resources

17 Conclusion Smoking cessation practices (5As) are not performed routinely Fee codes do not appear to provide sufficient incentive to engage in smoking cessation Perceived patient interest in quitting (or lack of it) is a critical factor for providing cessation services Ontario Tobacco Research Unit

18 Conclusion Improving access to training opportunities is important More dissemination activities to increase awareness of evidence-based guidelines, cessation resources and referral services Implementing a team care approach and systemlevel policies/practices is important Ontario Tobacco Research Unit

19 Thank You! Ontario Tobacco Research Unit