Provider feedback improves adherence with AHCPR Smoking Cessation Guideline

Background. This study evaluated the effect of primary care providers' adhe rence with the AHCPR Smoking Cessation Guideline after receiving a multicom ponent intervention. Methods. A quasi-experimental study with one intervention and one control t eam was conducted in a southeastern Veterans Affairs Medical Center primary care setting. During phase I, chart reviews were conducted to measure base line provider adherence and documentation of the four A's (ask, advise, ass ist, arrange). In phase II, the intervention team received a single educati onal session on the AHCPR Guideline, four A's, and tobacco dependence treat ment. This was followed by chart reviews of patients seen 4 to 8 weeks afte r the educational intervention to measure provider adherence and documentat ion of the four Ms. During phase III, the intervention team received indivi dual and team feedback from the chart reviews in phases I and II and booste r education on the AHCPR Guideline. Chart reviews were conducted from patie nt visits 4 to 8 weeks after the feedback and booster education to determin e provider adherence and documentation of the four A's. Results. A nested repeated measures two-factor analysis of variance was per formed for each of the following outcomes: ask, advise, assist, and arrange . Data analyses revealed that both the control and the intervention teams h ad 100% compliance in asking the patient about smoking status. There was a prestudy implementation of the vital sign stamp that included smoking statu s in this setting. Education on tobacco dependence and the AHCPR Guideline had no significant impact on provider performance with the advisement, assi stance, and arrangement of follow-up. However, significant improvements occ urred in the intervention team in the advisement (P = 0.05), assistance (P = 0.001), and arrangement of follow-up (P = 0.001) phase after individual a nd team feedback was provided. This research supports the fact that feedbac k impacts individuals and team performances and facilitated positive system changes to improve provider adherence with the AHCPR recommendations in tr eating tobacco dependence. (C) 2001 American Health Foundation and Academic Press.