| dc.description.abstract | TOBACCO CESSATION: A QUALITY IMPROVEMENT PROJECT USING THE 5 A’S MODEL Background: Tobacco use remains the leading preventable cause of death, disease, and disability in the United States. Current statistics show that approximately one in five American adults continue to smoke regularly. Tobacco smoking is responsible for approximately 480,000 premature deaths in the U.S. and over $300 billion each year in health care costs and productivity losses. Primary care providers have an excellent opportunity to help facilitate tobacco cessation with their patients. There are well-accepted and evidenced-based tobacco cessation tools in the literature that have proven to be effective in the clinical setting. Unfortunately, data suggest that consistent cessation treatments are not being provided. Project Aim: The aim of this quality and process improvement project was to address the inconsistency of usual care in tobacco cessation interventions within the primary care setting by implementing the 5 A’s model. Widely viewed as the gold standard guideline in addressing tobacco cessation and treatment, the 5 A’s are ask, advise, assess, assist, and arrange. Methods: The project took place at a nurse practitioner-based community center that provides primary care services. A pre-intervention questionnaire was administered to six nurse practitioner providers to assess baseline data regarding their current practice with facilitating tobacco cessation among patients. Education about the 5 A’s model and the plan for implementation was then provided to the providers and clinic staff by the Project Director during a staff in-service. One month following this intervention, the questionnaire was re-administered. The main outcome of interest was provider adherence to the elements of the 5 A’s model, which was measured by the pre- and post-intervention questionnaire. Results: Participants in the educational in-service revealed a high degree of baseline familiarity with the harms of tobacco and importance of treatment. Improvement was seen in staff familiarity with the 5 A’s model and implementation plan, as well as documentation and coding of tobacco use and dependence after the in-service. Six providers completed the pre-intervention questionnaire and three providers completed the post-intervention questionnaire. In 10 of the questionnaire items, the post-intervention weighted averages increased while in nine of the questionnaire items the post-intervention weighted averages decreased. There were four questionnaire items where the weighted averages were the same before and after. Overall, there was a slight positive shift when comparing the weighted averages from the pre-intervention questionnaire items to the post-intervention questionnaire items. However, it cannot be said that this is statistically significant (Z=-1.01, p=.31). Conclusion: While the in-service was effective in increasing staff familiarity with the 5 A’s model and plan for implementation, it did not improve provider adherence to the elements of the 5 A’s model. However, limited conclusions can be drawn given the project’s small sample size, attrition in participants, and methods of statistical analysis. | |
