title: Delivering evidence-based smoking cessation treatment in primary care practice: experience of Ontario family health teams.
abstract: OBJECTIVE
  To report on the delivery of evidence-based smoking cessation treatments (EBSCTs) within a sample of 40 Ontario family health teams (FHTs).
  
  
  METHODS
  In each FHT, consecutive patients were screened for smoking status and eligible patients completed a questionnaire immediately following their clinic visits (index visits). Multilevel analysis was used to examine FHT-level, provider-level, and patient-level predictors of EBSCT delivery.
  
  
  METHODS
  Forty FHTs in Ontario.
  
  
  METHODS
  Across the 40 participating FHTs, 24,033 patients were screened and 2501 eligible patients contributed data.
  
  
  METHODS
  Provider performance in the delivery of EBSCTs during the preceding 12 months and during the index visits was assessed.
  
  
  RESULTS
  The rate of provider delivery of EBSCT for the previous 12 months was 74.0% for the advise strategy. At the index visit, rates of EBSCT strategy delivery were 56.8% for ask; 46.9% for advise; 38.7% for assist; 11.6% for prescribing pharmacotherapy; and 11.3% for arrange follow-up. Significant intra-FHT and intraprovider variability in the rates of EBSCT delivery was identified. Family health teams with a physician champion (odds ratio [OR] 2.0; 95% CI 1.1 to 3.6; P < .01) and providers who highly ranked the importance of smoking cessation (OR 1.7; 95% CI 1.1 to 2.7; P < .01) were more likely to deliver EBSCTs. Patient readiness to quit (OR 1.6; 95% CI 1.3 to 1.9; P < .001), presence of smoking-related illness (OR 1.6; 95% CI 1.2 to 2.1; P < .01), and presenting for an annual health examination (OR 2.0; 95% CI 1.6 to 2.5; P < .001) were associated with the delivery of EBSCTs.
  
  
  CONCLUSIONS
  Rates of smoking cessation advice were higher than previously reported for Canadian physicians; however, rates of assistance with quitting were lower. Future quality improvement initiatives should specifically target increasing the rates of screening and advising among low-performing FHTs and providers within FHTs, with a particular emphasis on doing so at all clinic appointments; and improving the rate at which assistance with quitting is delivered.
authors.affiliation: Program Director of the Champlain Cardiovascular Disease Prevention Network & Primary Care Smoking Cessation Program in the Division of Prevention and Rehabilitation at the University of Ottawa Heart Institute (UOHI) and Assistant Professor in the Faculty of Medicine at the University of Ottawa in Ontario. SPapadakis@ottawaheart.ca.
authors.forename: Sophia
authors.initials: S
authors.lastname: Papadakis
authors.affiliation: Evaluation Coordinator at the UOHI.
authors.forename: Marie
authors.initials: M
authors.lastname: Gharib
authors.affiliation: Project Manager and Facilitator at the UOHI.
authors.forename: Josh
authors.initials: J
authors.lastname: Hambleton
authors.affiliation: Deputy Chief of the Division of Prevention and Rehabilitation at the UOHI and Full Professor in the Faculty of Medicine at the University of Ottawa.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.affiliation: Research Coordinator at the UOHI.
authors.forename: Roxane
authors.initials: R
authors.lastname: Assi
authors.affiliation: Professor in the Faculty of Medicine at the University of Ottawa and Chief of the Division of Prevention and Rehabilitation at the UOHI.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pipe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010808:Physical Examination; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*