Abstract Introduction Although effective treatments for smoking cessation are well established, they remain inconsistently implemented in clinical practice. Persistent barriers - such as limited provider time and the financial resources required to maintain a conventional tobacco specialist referral model - have hindered widespread adoption. To address these challenges, a point-of-care, electronic health record-enabled, evidence-based, tobacco treatment program (ELEVATE) was implemented at a large medical center to integrate cessation support directly into routine clinical workflows as an effort to overcome these barriers. In the six months following implementation in pulmonary clinics, tobacco treatment reach increased from 42% to 47%, and provision of behavioral support increased from 0.6% to 24%. In this study, we conducted an assessment to evaluate the implementation process and to identify key facilitators and barriers that could inform future adaptations of this model to improve its adoption. Methods A parallel, convergent design, mixed methods needs assessment was conducted with clinical providers and staff that provide care in the pulmonary clinics at a large academic center. Physicians, advanced practice providers (APPs), medical assistants (MA), and registered nurses (RN) were surveyed and interviewed about current smoking cessation management practices, their awareness of the point-of-care smoking model, and facilitators/barriers to the implementation of this model. Interviews were recorded, transcribed and then coded with themes that were described in relation to the Consolidated Framework for Implementation Research (CFIR). Results There were 42 surveys completed from 31 physicians, 2 APPs, 4 RNs, 4 MAs, and 1 MA supervisor. Most participants were female (52.4%) and the median years of clinical experience was 6 years. Up to 50.0% of responses reported that lack of provider time was at least somewhat a barrier to effective smoking cessation. In addition, participants disagreed with both familiarity of the model (85.7%) and awareness of its rollout within the clinic (80.9%). Participants also disagreed (32.5%) with the treatment model improving smoking cessation management in the clinic. Significant barriers and facilitators of the implementation of the model identified during the interviews are listed in Table 1. Conclusions Despite an increase in tobacco treatment reach with the implementation of a point-of-care tobacco treatment, there remained a general unawareness of this process within the pulmonary clinic. However, there was a consensus that a point-of-care approach has benefits over conventional approaches. Identification of barriers and facilitators provides an avenue of focus to guide adaptations of the model to improve its implementation. This abstract is funded by: NIH CTSA Grant UL1TR002345
Khodadadi et al. (Fri,) studied this question.