Implementing National Tobacco Cessation Guidelines in Primary Care: A Practice Improvement Project

Background and Purpose: National guidelines recommend tobacco cessation counseling at every clinic visit using the 5 A’s, defined as asking about status, advising to quit, assessing readiness to quit, assisting in quitting, and arranging for follow-up after quitting. However, providers cite barriers such as lack of time and personal discomfort with the subject as reasons conversations are not held. This practice improvement focuses on overcoming these barriers through an evidence-based intervention in a small, urban, primary care clinic. Methods: A onetime staff education session about guidelines paired with a protocol algorithm and enhanced patient resources was trialed to determine its effect on the frequency of charted cessation conversations. An electronic health record documentation template, or dot phrase, measured the frequency of 5 A use in clinic visits for identified tobacco users. Providers received performance feedback twice during eight weeks of data collection. An attitude survey, administered before implementation and upon completion of data collection, determined the effect of the intervention on provider attitudes toward discussing tobacco use. Conclusions: The average frequency of use of the dot phrase was above the goal of 50% during the data collection period. Frequency of charting of all 5 A’s was higher during the data collection period than at baseline. Provider attitudes about discussing cessation demonstrated no significant changes, based on baseline and post-implementation survey responses. Implications for Practice: Education and enhanced resources to facilitate tobacco cessation conversations have a positive impact on the frequency that clinic providers document tobacco cessation conversations with identified tobacco users