Improving Tobacco Cessation Processes for Behavioral Health Professionals in Primary Care

Abstract

Purpose. The purpose of this quality improvement project was to develop evidence-based tobacco cessation recommendations through a pre-program evaluation of current tobacco cessation processes at a Federally Qualified Health Center in Casa Grande, Arizona. The primary investigator explored tobacco screening and counseling practices within the behavioral health department. The project took place alongside two similar projects focused on the pharmacy and primary care departments. Together the three projects functioned together to develop evidence-based recommendations, for implementation by future Doctor of Nursing Practice student cohorts. Background. Healthcare professionals experience multifactorial barriers that impact consistent delivery of evidence-based tobacco cessation interventions. The U.S. Preventative Service Task Force endorses two clinical practice guidelines that highlight a system-based approach for treating tobacco dependence. Guideline recommendations help to ensure consistent documentation and delivery of cessation interventions for tobacco users at every clinical encounter. Unfortunately, literature demonstrates inconsistent documentation practices, which result in missed opportunities to deliver proven interventions. Methods. The project analyzed current tobacco cessation processes among the facility’s behavioral health professionals. The focused evaluation used a survey tool developed from literature. The survey identified current tobacco screening and counseling processes and informed comprehensive recommendations developed to improve future tobacco cessation processes. Results. Of the four potential participants, three behavioral health professionals completed the survey (N = 3). Participants varied how frequently they inquired about tobacco use. However, they all reported delivering cessation interventions and made appropriate evidence-based recommendations. Two participants referred tobacco users not taking FDA approved medication to primary care. All participants felt confident counseling tobacco users and found ways to stay current with tobacco cessation recommendations. Consistent with current literature participants identified patient motivation was the leading counseling barrier. Conclusions. The project successfully identified current tobacco cessation processes and the top perceived barriers of behavioral health professionals. It underlined the important role of behavioral health professionals in tobacco cessation and demonstrated they are engaged, confident, and knowledgeable about the topic. Although barriers exist, the integrated patient care model at the Federally Qualified Health Center provides an opportunity to design a comprehensive program to seamlessly move tobacco users through the continuum of care.