Implementing tobacco interventions in the real world of managed care

Over the years we have been working to develop, test, and implement tobacco control interventions as a part of routine care within Kaiser Permanente. Most of our work has been in Kaiser Permanente's northwest division, based in Portland, Oregon, but we have also implemented similar approaches in several other divisions, including Ohio, Hawaii, and Georgia. I will first describe our general approach, which we call the TRAC model ("tobacco reduction, assessment, and care"), and then share both our progress and some very real diYculties we have encountered in trying to implement the program throughout the health care system.