Front-office staff can improve clinical tobacco intervention: Health coordinator pilot project

Article Figures & Data

Table 1.

Project plan for the Health Coordinator Pilot (2008–2010)

PHASES	CENTRAL PROJECT ACTIVITIES	PRACTICE-LEVEL ACTIVITIES
First 9 months	Recruit HCs Develop clinical methods and instruments; develop training and data management tools Provide HCs with ongoing support	Provide HCs with orientation for the project; training for data management and CTI Complete baseline survey Participate in telephone conferences and Web forum
Months 10–21	Analyze baseline survey Support HCs with implementing CTI Adapt CTI materials and methods for other 3 risks^* Address clinical, administrative, and data management issues Support HCs to do follow-up survey	Identify smoking patients; offer CTI; track CTI on spreadsheet Consult clinicians regarding individual patients Participate in teleconferences and Web forum Train for addressing other 3 risks^* Complete follow-up survey
Months 22–24	Analyze follow-up survey Support HCs to do CTI and help with other 3 risks^* Prepare and submit final report	Continue supporting smoking patients with CTI and other 3 risks^* Aid practices and patients to transition to post- project routines

Table 2.

Participant characteristics at each clinic site at baseline and follow-up

CLINIC SITE	N	SMOKING PREVALENCE N (%)	FEMALE SEX, %	*PATIENTS AGED > 65 Y,^ %**	CDM PATIENTS, %	SMOKING STATUS UNKNOWN,^† %	READINESS TO QUIT ASSESSED,^‡ %
Baseline
• A	325	75 (23)	63	34	28	22	48
• C	496	65 (13)	46	20	36	0	45
• D	247	9 (4)	74	18	17	58	0
• E	296	61 (21)	53	27	29	10	28
• F	201	122(61)	32	6	2	25	0
• Total	1565	332(21)	54	23	27	27	25
Follow-up
• A	301	46 (15)	59	45	23	9	85
• C	301	56 (19)	51	28	26	6	34
• D	220	5 (2)	48	34	42	78	100
• E	300	62 (21)	59	32	25	6	19
• F	187	119(64)	25	7	9	20	38
• Total	1309	288(22)	50	31	25	21	42

CDM—chronic disease management.
↵* A minor change in the age groupings occurred at follow-up when a pull-down system was used to aid data entry, so follow-up data are for patients aged older than 60 y.
↵† Refers to all patients.
↵‡ Refers to smoking patients.

Table 3.

Patients reached in baseline and follow-up medical record surveys

VARIABLE	BASELINE	FOLLOW-UP
No. of practices	6 practices reviewed records; data from 5 are included^*	5 practices reviewed records
No. of records reviewed	1565	1309^†
No. of smokers	332	288
Smoking prevalence, %	21	22
Male sex, %	46	50
Adult patients, %	72 (20–64 y)^‡	66 (19–60 y)^‡

CDM—chronic disease management, HC—health coordinator.
↵* Data from clinic site B have been omitted because its HC, originally assigned from the health region, was reassigned elsewhere and this practice had no other staff available to continue the pilot. Its baseline survey results were close to the mean for number of records and patient age, sex, and CDM status. However, site B had the largest proportion of patients with unknown smoking status (mean 70% vs 27% for other 5 practices).
↵† The smaller number of records reviewed at follow-up reflects the increased demands on HCs’ time from patient workload, which did not exist at baseline.
↵‡ A minor change in the age groupings occurred at follow-up when a pull-down system was used to aid data entry.

Table 4.

Proportion of smokers in each clinic with each of the intervention components noted in their charts at baseline and follow-up

CLINIC SITE	SMOKING PREVALENCE, N (%)	CHART REMINDER, %	ADVICE TO QUIT, %	SELF-MANAGEMENT PLAN, %	TARGET QUIT DATE, %	REFERRAL, %	FOLLOW-UP DATE, %
Baseline
• A	75 (23)	84	48	31	16	23	27
• C	65 (13)	1	86	22	3	0	3
• D	9 (4)	0	11	0	0	0	0
• E	61 (21)	2	34	18	3	3	3
• F	122(61)	0	0	1	0	0	0
• Total	332(21)	20	34	14	5	6	7
Follow-up
• A	46 (15)	98	85	28	24	24	30
• C	56 (19)	88	96	61	2	2	55
• D	5 (2)	80	100	60	20	20	20
• E	62 (21)	100	97	18	0	16	18
• F	119(64)	93	58	86	13	6	54
• Total	288(22)	94	79	57	11	11	42

Table 5.

Documented intervention components offered to smokers

INTERVENTION COMPONENT	*BASELINE (N = 332^), N (%)**	FOLLOW-UP (N = 288^†), N (%)	P VALUE^‡
Tobacco
• Chart reminder	65 (20)	272 (94)	< .001
• Advice to change	114 (34)	227 (79)	< .001
• Self-management plan	48 (14)	164 (57)	< .001
• Target quit date	16 (5)	29 (10)	.02
• Referral	19 (6)	30 (10)	.04
• Follow-up date	24 (7)	121 (42)	< .001
Physical inactivity
• Chart reminder	1 (0)	23 (8)	< .001
• Advice to change	33 (10)	71 (25)	< .001
• Self-management plan	24 (7)	43 (15)	.002
• Target quit date	1 (0)	4 (1)	> .05
• Referral	0 (0)	4 (2)	.04
• Follow-up date	2 (1)	34 (12)	< .001
At-risk alcohol use
• Chart reminder	19 (6)	8 (3)	> .05
• Advice to change	10 (3)	8 (3)	> .05
• Self-management plan	8 (2)	14 (5)	> .05
• Target quit date	3 (1)	2 (1)	> .05
• Referral	6 (2)	3 (1)	> .05
• Follow-up date	7 (2)	9 (3)	> .05
Depression
• Chart reminder	10 (3)	61 (21)	< .001
• Advice to change	24 (7)	71 (25)	< .001
• Self-management plan	20 (6)	66 (23)	< .001
• Target quit date	5 (2)	23 (8)	< .001
• Referral	16 (5)	22 (8)	> .05
• Follow-up date	19 (6)	60 (21)	< .001

↵* Out of 1565 baseline records (21%)
↵† Out of 1309 follow-up records (22%)
↵‡ P values were estimated using the Mann-Whitney test (nonparametric) for comparing 2 independent groups.