scholarly journals A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol

2020 ◽  
Author(s):  
Erin Rogers ◽  
Christina Wysota ◽  
Judith J. Prochaska ◽  
Craig Tenner ◽  
Joanna Dognin ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Treatment Guidelines ◽  
Treatment Approach ◽  
Randomized Study ◽  
Intervention Period ◽  
Structured Interviews ◽  
Clinical Reminder ◽  
Tobacco Treatment ◽  
Opt Out ◽  
Outpatient Psychiatry

Abstract BackgroundPeople with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a ‘no treatment’ default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3A’s (ask, advise, assist) tobacco treatment model in outpatient psychiatry.MethodsWe will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of two groups: (1) Opt-In Treatment Approach: Psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; or (2) Opt-Out Treatment Approach: Psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-hour training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study’s primary outcomes: 1) the percent of smokers prescribed a cessation medication and 2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3 A’s approach and patient perceptions of the opt-out system. At six months, we will survey the clustered patient sample again to evaluate the study’s secondary outcomes: 1) patient use of cessation treatment in the prior 6 months and 2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12-14 psychiatrists asking about their perceptions of the opt-out approach. DiscussionThis study will produce important data on the potential of opt-out systems to overcome barriers in implementing tobacco use treatment in outpatient psychiatry.

scholarly journals A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol

2020 ◽  
Author(s):  
Erin Rogers ◽  
Christina Wysota ◽  
Judith J. Prochaska ◽  
Craig Tenner ◽  
Joanna Dognin ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Treatment Guidelines ◽  
Treatment Approach ◽  
Randomized Study ◽  
Intervention Period ◽  
Structured Interviews ◽  
Clinical Reminder ◽  
Tobacco Treatment ◽  
Opt Out ◽  
Outpatient Psychiatry

Abstract Background People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a ‘no treatment’ default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3A’s (ask, advise, assist) tobacco treatment model in outpatient psychiatry. Methods We will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of two groups: (1) Opt-In Treatment Approach: Psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; or (2) Opt-Out Treatment Approach: Psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-hour training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study’s primary outcomes: 1) the percent of smokers prescribed a cessation medication and 2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3 A’s approach and patient perceptions of the opt-out system. At six months, we will survey the clustered patient sample again to evaluate the study’s secondary outcomes: 1) patient use of cessation treatment in the prior 6 months and 2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12-14 psychiatrists asking about their perceptions of the opt-out approach. Discussion This study will produce important data on the potential of opt-out systems to overcome barriers in implementing tobacco use treatment in outpatient psychiatry.

scholarly journals Potential Social, Environmental, and Regulatory Threats to Electronic Health Record Strategies for Improving Tobacco Treatment in Healthcare

2013 ◽  
Vol 8 (2) ◽  
pp. 106-114
Author(s):  
Frank T. Leone ◽  
Sarah Evers-Casey ◽  
Michael J. Halenar ◽  
Keiren O'Connell ◽  
Keyword(s):  
Tobacco Use ◽  
Treatment Guidelines ◽  
Topic Area ◽  
Healthcare Settings ◽  
Tobacco Treatment ◽  
Potential Impact ◽  
Electronic Health ◽  
Social Environmental ◽  
The Impact ◽  
Optimal Implementation

Introduction– The potential impact of electronic health records (EHR) in driving tobacco treatment behaviours within healthcare settings has been established. However, little is known about the administrative variables that may undermine effectiveness in real world settings.Aims– Assist healthcare planners interested in implementing tobacco-EHR systems by identifying an EHR framework that is consistent with published treatment guidelines, and the important organisational variables that can undermine the effectiveness of tobacco-EHR.Methods– This paper considers the established literature on EHR implementation and physician behaviour change, and integrates this understanding with the observations of an expert workgroup tasked with facilitating tobacco-EHR implementation in Southeastern Pennsylvania.Results/ Findings– System change in this topic area will continue to be problematic unless attention is paid to several important lessons regarding: 1) the evolving healthcare regulatory environment, 2) the integration of tobacco use treatment into primary care, and 3) the existing social and organisational barriers to uptake of evidence-based recommendations.Conclusion– Healthcare organisations seeking to reduce the impact of tobacco use on their patients are well served by tobacco-EHR systems that improve care. Managers can avoid sub-optimal implementation by considering several threats to effectiveness before proceeding to systems change.

scholarly journals A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Erin S. Rogers ◽  
Christina Wysota ◽  
Judith J. Prochaska ◽  
Craig Tenner ◽  
Joanna Dognin ◽  
...  
Keyword(s):  
Study Protocol ◽  
Treatment Guidelines ◽  
Randomized Study ◽  
Behavioral Economic ◽  
Tobacco Treatment

scholarly journals Design and Pilot Implementation of an Electronic Health Record-Based System to Automatically Refer Cancer Patients to Tobacco Use Treatment

2020 ◽  
Vol 17 (11) ◽  
pp. 4054 ◽  
Author(s):  
Thulasee Jose ◽  
Joshua W. Ohde ◽  
J. Taylor Hays ◽  
Michael V. Burke ◽  
David O. Warner
Keyword(s):  
Electronic Health Record ◽  
Cancer Patients ◽  
Tobacco Use ◽  
Mayo Clinic ◽  
Cancer Center ◽  
Health Record ◽  
Oncology Patients ◽  
Tobacco Treatment ◽  
Opt Out ◽  
Electronic Health

Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use(“opt out”). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based “opt-out” approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.

scholarly journals The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019

2021 ◽  
Vol 18 (5) ◽  
pp. 2416
Author(s):  
Christine E. Sheffer ◽  
Abdulmohsen Al-Zalabani ◽  
Andrée Aubrey ◽  
Rasha Bader ◽  
Claribel Beltrez ◽  
...  
Keyword(s):  
North America ◽  
Tobacco Use ◽  
Training Programs ◽  
Systems Of Care ◽  
Eastern Mediterranean ◽  
Annual Number ◽  
Treatment Services ◽  
Tobacco Treatment ◽  
The World ◽  
Academic Settings

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

scholarly journals Secondary Data Usage in Direct-to-Consumer Genetic Testing: To What Extent Are Customers Aware and Concerned?

2021 ◽  
pp. 1-8
Author(s):  
Janessa Mladucky ◽  
Bonnie Baty ◽  
Jeffrey Botkin ◽  
Rebecca Anderson
Keyword(s):  
Genetic Testing ◽  
Secondary Data ◽  
Structured Interviews ◽  
Customer Data ◽  
Secondary Use ◽  
Data Usage ◽  
Direct To Consumer ◽  
New Information ◽  
Opt Out ◽  
Potential Risks

Introduction: Customer data from direct-to-consumer genetic testing (DTC GT) are often used for secondary purposes beyond providing the customer with test results. Objective: The goals of this study were to determine customer knowledge of secondary uses of data, to understand their perception of risks associated with these uses, and to determine the extent of customer concerns about privacy. Methods: Twenty DTC GT customers were interviewed about their experiences. The semi-structured interviews were transcribed, coded, and analyzed for common themes. Results: Most participants were aware of some secondary uses of data. All participants felt that data usage for research was acceptable, but acceptability for non-research purposes varied across participants. The majority of participants were aware of the existence of a privacy policy, but few read the majority of the privacy statement. When previously unconsidered uses of data were discussed, some participants expressed concern over privacy protections for their data. Conclusion: When exposed to new information on secondary uses of data, customers express concerns and a desire to improve consent with transparency, more opt-out options, improved readability, and more information on future uses and potential risks from direct-to-consumer companies. Effective ways to improve readership about the secondary use, risk of use, and protection of customer data should be investigated and the findings implemented by DTC companies to protect public trust in these practices.

scholarly journals An Interdisciplinary Response to a Tobacco Cessation Case Vignette

2016 ◽  
Vol 12 (3) ◽  
pp. 153-164
Author(s):  
Chad D. Morris ◽  
Donna L. Richardson ◽  
Jill M. Loewen ◽  
Laura C. Vanheest ◽  
Angela Brumley-Shelton ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Cessation ◽  
Interdisciplinary Approach ◽  
Chronic Illnesses ◽  
Mental Illnesses ◽  
Case Vignette ◽  
Care Needs ◽  
Healthcare Settings ◽  
Tobacco Treatment ◽  
Complex Care Needs

Introduction:Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.Aims:The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.Methods:ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.Results/Findings:While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.Conclusions:Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services.

scholarly journals Agenda-setting of tobacco control policy in Iran: a retrospective policy analysis study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hamid Ravaghi ◽  
Sogand Tourani ◽  
Rahim Khodayari-Zarnaq ◽  
Baharak Aghapour ◽  
Azita Pishgoo ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Tobacco Use ◽  
Agenda Setting ◽  
Age Of Onset ◽  
Process Analysis ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Policy Documents ◽  
Policy Window ◽  
National Control

Abstract Background The prevalence of tobacco use, especially hookah, has increased in Iran In recent years, particularly among young people and women, and the age of onset of use has decreased. Tobacco use is the fourth leading risk factor for non-communicable diseases in Iran. These issues cause concerns in the country and led to the present study on tobacco control agenda-setting in Iran over a 30-year timeframe. Methods We conducted this retrospective analytical study to investigate process analysis in Iran using Kingdon’s multiple-streams framework (MSF). We collected the data using semi-structured interviews with key informants (n = 36) and reviewing policy documents (n > 100). Then, we analyzed the policy documents and in-depth interviews using the document and framework analysis method. We used MAXQDA 11 software to classify and analyze the data. Results Iran’s accession to the Framework Convention on Tobacco Control (FCTC) opened a window of opportunity for tobacco control. The policy window opens when all three streams have already been developed. The adoption of the comprehensive law on the national control and campaign against tobacco in the Islamic Consultative Assembly in 2006 is a turning point in tobacco control activities in Iran. Conclusions The tobacco control agenda-setting process in Iran was broadly consistent with MSF. The FCTC strengthened the comprehensive plan for national control of tobacco as a policy stream. However, there are several challenges in developing effective policies for tobacco control in the Iranian setting.

Impact of a tobacco cessation intervention on adherence to tobacco use treatment guidelines among village health workers in Vietnam

2019 ◽  
Vol 27 (3) ◽  
pp. 24-33
Author(s):  
Nam Nguyen ◽  
Trang Nguyen ◽  
Van Truong ◽  
Kim Dang ◽  
Nina Siman ◽  
...  
Keyword(s):  
Community Health ◽  
Tobacco Use ◽  
Self Efficacy ◽  
Community Health Centers ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Health Centers ◽  
Care Providers ◽  
Village Health Workers ◽  
Village Health

Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers’ and village health workers’ adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers’ adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers’ adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.

Opt-out stories: women’s decisions to leave corporate leadership

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Robin Ayers Frkal ◽  
Noel Criscione-Naylor
Keyword(s):  
Racial Diversity ◽  
Small Sample ◽  
Corporate Leadership ◽  
Structured Interviews ◽  
Leadership Positions ◽  
Content Type ◽  
Authentic Self ◽  
Social Media Networks ◽  
Opt Out ◽  
Decisions To Leave

Purpose The purpose of this paper is to explore how the challenges to women’s authentic leadership identities contribute to their decisions to abandon leadership positions mid-career. It examines the critical career moments and underlying themes behind these women’s decisions to leave. Design/methodology/approach This paper is based on semi-structured interviews (n = 9) with women between the ages of 32-53 who had opted-out of mid-level corporate leadership positions. Findings The study found that work–life balance was not the primary factor in women’s decisions to leave. Instead, the women in the study reflected on their inability to be themselves and contribute perceived value to the organization as triggering their decisions to leave. Research limitations/implications There are limitations in using a small sample of women selected through the researchers’ social media networks resulting in limited cultural and racial diversity. Practical implications Misconceptions about women’s decisions to leave corporate leadership mid-career misleads human resource (HR) practices and initiatives focused on retaining female talent. Organizations need to recognize and reshape the organizational environment to support women to be their authentic self and make the value of their contributions more transparent. Originality/value The paper is original in that it examines opt-out from the lens of women’s leadership identities in corporate contexts. There are limited studies that have examined the connections between identity and women’s career decisions beyond work–ife balance. It provides practical value to HR practitioners and organizations focused on retaining female talent.

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