Reducing Tobacco Use and Secondhand Smoke Exposure: Provider Reminders with Provider Education – Inactive

These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure.

• For interventions that included at least a provider reminder system and a provider education program:
  • The number of clients who received advice from a provider to quit tobacco use increased by a median of 20.0 percentage points.
  • There was a median 4.7 percentage point increase in the number of clients who quit tobacco use.
• For interventions that included provider reminders, provider education and client education:
  • Provider advice to quit increased by a median of 22.0 percentage points.
  • The number of clients who quit increased by a median of 5.7 percentage points.
• These programs are applicable in different settings, populations, and with different forms of tobacco.
• Studies were carried out in a variety of healthcare settings including HMOs, private practices, physician training programs, and public health clinics as well as in provider populations such as primary care, internal, and family medicine.

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Effectiveness

The effectiveness of recommended and strongly recommended interventions in this section (i.e., multicomponent provider reminder plus provider education with or without patient education materials; provider reminder systems alone; multicomponent interventions that include telephone cessation support; and reduction of patient out-of-pocket costs for cessation) is established. However, research issues regarding the effectiveness of these interventions remain.

• Which characteristics of provider-based interventions contribute to increased or decreased effectiveness?
• What are the least and most effective combinations of services in multicomponent interventions?
• What is the effect of provider reminder systems on patient tobacco use cessation when implemented alone?
• What is the relative effectiveness of provider reminders that focus on determination of patient tobacco use status versus reminders that prompt for delivery of advice to quit?
• How do content and method of delivery of provider reminders relate to effectiveness?
• Can reducing patient costs for effective cessation services increase the effectiveness of provider-based interventions?
• What is the most effective level of implementation for telephone cessation support services?
• Is the use and effectiveness of telephone cessation support increased when community and clinical cessation support programs are coordinated? Because the effectiveness of two interventions (provider education when used alone and provider feedback systems) has not been established, basic research questions remain. This is especially true for provider assessment and feedback systems for which the number of available studies was small.

Because the effectiveness of two interventions (provider education when used alone and provider feedback systems) has not been established, basic research questions remain. This is especially true for provider assessment and feedback systems for which the number of available studies was small.

• What are the effects of provider assessment and feedback interventions on provider delivery of advice to quit to tobacco-using patients? On patient tobacco use cessation?
• What is the effectiveness of HEDIS, as a form of assessment, feedback, and benchmarking, in improving patient receipt of advice to quit and patient tobacco use cessation? Does effectiveness vary by practice setting?
• What frequency, duration, and format of provider education efforts are required to obtain consistent improvements in provider performance and patient response?

Applicability

Each recommended and strongly recommended provider-based intervention should be applicable in most relevant target populations and settings. However, possible differences in the effectiveness of each intervention for specific subgroups of patient and provider populations could not be determined. Several questions regarding the applicability of these interventions in settings and populations other than those studied remain.

• Do provider-based interventions differ in effectiveness in different patient populations?
• Are provider-based interventions effective in increasing cessation or in reducing initiation in adolescent populations?
• Do significant differences exist regarding the effectiveness of these interventions, based on the level of scale at which they are delivered?

Other Positive or Negative Effects

With the exception of the use of provider reminder systems to prompt action on other preventive services, studies in this review did not report on other positive and negative effects of these interventions. Research on the following questions would be useful:

• Do provider-based interventions for tobacco use cessation interfere with office flow or efficiency? If so, how can this effect be minimized?
• Do provider-based interventions increase or decrease the delivery of other preventive services?

Economic Evaluation

Available economic information was limited in this section. Considerable research is warranted regarding the following questions:

• What are the costs for provider-based interventions?
• What are the costs for patient-based interventions?
• How do the costs per additional quitter compare with other interventions intended to reduce tobacco use?
• What is the cost-benefit, cost-utility, or the cost per illness averted of these interventions?
• What is the cost-effectiveness for provider interventions that target tobacco alone compared with provider interventions that target multiple preventive services?

Barriers

Research questions regarding the potential barriers identified for the interventions evaluated in this section include the following:

• How can provider-based interventions that place minimal administrative burden on providers or systems be implemented?
• What information is needed to overcome potential barriers to the implementation of provider assessment and feedback interventions?
• What information is needed to overcome potential barriers to reducing patient out-of-pocket costs for effective cessation therapies?
• What is the effect on use of combining effective pharmacologic therapies and behavioral programs as a criterion for reimbursement? What is the effect on use and effectiveness if these cessation options are provided independently?

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