title: Tobacco use disorder treatment in primary care: implementing a clinical system pathway in Alberta.
abstract: OBJECTIVE
  To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Sixty primary care sites in Alberta.
  
  
  METHODS
  A convenience sample of 198 primary care physicians from the population of 2857.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Assistant Professor in the Faculty of Nursing, Adjunct Professor in the John Dossetor Health Ethics Centre, and Associate Researcher in the Centre for Effective Business Management of Addiction Treatment at the University of Alberta in Edmonton. diane.kunyk@ualberta.ca.
authors.forename: Diane
authors.initials: D
authors.lastname: Kunyk
authors.affiliation: Academic faculty member in the Faculty of Medicine and Dentistry, the School of Public Health, and the John Dossetor Health Ethics Centre at the University of Alberta.
authors.forename: Charl
authors.initials: C
authors.lastname: Els
authors.affiliation: Assistant Professor in the Division of Cardiology in the Faculty of Medicine at the University of Ottawa in Ontario and Program Director for the Chaplin CVD Prevention Network Primary Care Smoking Cessation Program in the Division of Prevention and Rehabilitation at the Ottawa Heart Institute.
authors.forename: Sophia
authors.initials: S
authors.lastname: Papadakis
authors.affiliation: Chief of the Addictions Program and Clinician Scientist at the Centre for Addiction and Mental Health in Toronto, Ont, Associate Professor in the Department of Family and Community Medicine, the Department of Psychiatry, and the Dalla Lana School of Public Health at the University of Toronto, and Principal Investigator at the Ontario Tobacco Research Unit.
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
mesh_terms: D000416:Alberta; D000465:Algorithms; D001291:Attitude of Health Personnel; D019091:Critical Pathways / Q000458:organization & administration; D006801:Humans; D057194:Intention to Treat Analysis; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D011446:Prospective Studies; D014029:Tobacco Use Disorder / Q000628:therapy*