title: Academic Detailing Interventions Improve Tobacco Use Treatment among Physicians Working in Underserved Communities.
abstract: BACKGROUND
  Tobacco use disproportionately affects the poor, who are, in turn, least likely to receive cessation treatment from providers. Providers caring for low-income populations perform simple components of tobacco use treatment (e.g., assessing tobacco use) with reasonable frequency. However, performance of complex treatment behaviors, such as pharmacologic prescription and follow-up arrangement, remains suboptimal.
  
  
  OBJECTIVE
  Evaluate the influence of academic detailing (AD), a university-based, noncommercial, educational outreach intervention, on primary care physicians' complex treatment practice behaviors within an urban care setting.
  
  
  METHODS
  Trained academic detailers made in-person visits to targeted primary care practices, delivering verbal and written instruction emphasizing three key messages related to tobacco treatment. Physicians' self-reported frequency of simple and complex treatment behaviors were assessed using a seven-item questionnaire, before and 2 months after AD.
  
  
  RESULTS
  Between May 2011 and March 2012, baseline AD visits were made to 217 physicians, 109 (50%) of whom also received follow-up AD. Mean frequency scores for complex behaviors increased significantly, from 2.63 to 2.92, corresponding to a clinically significant 30% increase in the number of respondents who endorsed "almost always" or "always" (P < 0.001). Improvement in mean simple behavior frequency scores was also noted (3.98 vs. 4.13; P = 0.035). Sex and practice type appear to influence reported complex behavior frequency at baseline, whereas only practice type influenced improvement in complex behavior scores at follow up.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility and potential effectiveness of a low-cost and highly disseminable intervention to improve clinician behavior in the context of treating nicotine dependence in underserved communities.
authors: 1 Division of Pulmonary and Critical Care Medicine, Leonard Davis Institute of Health Economics.|2 Comprehensive Smoking Treatment Program.
authors: Frank T
authors: FT
authors: Leone
authors: 2 Comprehensive Smoking Treatment Program.
authors: Sarah
authors: S
authors: Evers-Casey
authors: 2 Comprehensive Smoking Treatment Program.
authors: Sarah
authors: S
authors: Graden
authors: 3 Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, and the Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors: Robert
authors: R
authors: Schnoll
authors: 4 Philadelphia Department of Public Health, Philadelphia, Pennsylvania.
authors: Giridhar
authors: G
authors: Mallya
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D015143:Philadelphia; D058007:Physicians, Primary Care / Q000193:education / Q000523:psychology; D011203:Poverty; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D058996:Quality Improvement; D057566:Self Report; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D014029:Tobacco Use Disorder / Q000628:therapy*
keywords: academic training; nicotine; physician’s practice patterns; smoking cessation; tobacco use disorder