Abstract
Background: Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings.Purpose: We examined issues related to the implementation of guidelines in MCOs, to provide examples of studies that have addressed issues related to guideline implementation and to suggest ways behavioral medicine researchers can play a role in examining issues of how guidelines can be better implemented.Methods: Surveys of clinical guideline implementation, studies from the Robert Wood Johnson Foundation addressing tobacco use cessation in a managed care database, selected to illustrate issues related to system-wide implementation.Results: Surveys show that effective tobacco use cessation interventions remain underutilized in MCOs. A few studies have evaluated and shown the benefit of insurance coverage for tobacco use and dependence treatments, clinician reimbursement and leadership incentives, practice feedback, and leveraging administrative data to create tobacco use tracking systems. The studies also point to the need for large-scale, multidisciplinary, methodologically rigorous studies that allow one to isolate the effects of promising strategies as well as to explore synergistic effects as different system changes are combined.Conclusions: Tobacco use cessation guidelines need to be better implemented in MCOs. Behavioral medicine research needs to move beyond treatment efficacy and effectiveness studies to focus on rigorous evaluations of these and other strategies to enhance guideline implementation and dissemination.
Similar content being viewed by others
References
U.S. Department of Health and Human Services:Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2000.
Slade J, Henningfield JE: Tobacco product regulation: Context and issues.Food and Drug Law Journal. 1998,53(Suppl.):43–74.
Fiore MC, Bailey WC, Cohen SJ, et al.:Smoking Cessation: Clinical Practice Guideline No. 18. Rockville, MD: U.S. Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1996.
Fiore MC, Bailey, WC, Cohen SJ, et al.: A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report.Journal of the American Medical Association. 2000,283:3244–3254.
Fiore MC, Bailey WC, Cohen SJ, et al.:Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2000.
Institute for the Future:Health and Health Care 2010: The Forecast, the Challenge. San Francisco: Jossey-Bass, 2000.
Strunk BC, Reschovsky JD:Kinder and Gentler: Physicians and Managed Care (Tracking Report No. 5). Washington, DC: Center for Studying Health System Change, 2002.
Curry SJ, Fiore MC, Orleans CT, Keller P: Addressing tobacco in managed care: Documenting the challenges and potential for systems-level change.Nicotine and Tobacco Research, 2002,4:5–7.
Orleans CT, Abrams DB, Gruman JC: Will healthcare take tobacco addiction seriously? Using policy to drive practice.Med-scape General Medicine. 2001,3:1–5.
Hopkins DP, Briss PA, Ricard CJ, et al.: Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke.American Journal of Preventive Medicine. 2001,20(Suppl. 2): 16–66.
Hopkins DP, Husten CG, Fielding JE, Rosenquist JN, Westphal LL: Evidence reviews and recommendations on interventions to reduce tobacco use and exposure to environmental tobacco smoke: A summary of selected guidelines.American Journal of Preventive Medicine. 2001,20(Suppl. 2):67–87.
McPhillips-Tangum C, Cahill A, Bocchino C, Cutler CM: Addressing tobacco in managed care: Results of the 2000 survey.Preventive Medicine in Managed Care. 2002,3:85–94.
Rigotti NA, Quinn VP, Stevens VJ, et al.: Tobacco-control policies in 11 leading managed care organizations: Progress and challenges.Effective Clinical Practice. 2002,5:130–136.
Goldstein MG, DePue JD, Monroe AD, et al.: A population-based survey of physician smoking cessation counseling practices.Preventive Medicine. 1998,27:720–729.
SchaufflerHH, Barker DC, Orleans CT: Medicaid coverage forto-bacco-dependence treatments.Health Affairs. 2001,20:298–303.
Schauffler HH, Mordavsky S, McMenamin S: Adoption of ACPR clinical practice guidelines for smoking cessation: A survey of California HMOs.American Journal of Preventive Medicine. 2001,321:153–161.
Curry SJ: Organizational interventions to encourage guideline implementation.Chest. 2000,118:40S-46S.
Katz DA, Muehlenbruch DR, Brown B, Fiore MC, Baker TB: Effectiveness of a clinic-based strategy for implementing the AHRQ smoking cessation guideline in primary care.Preventive Medicine. 2002,25:293–302.
Solberg LI, Brekke ML, Fazio CJ, et al.: Lessons from experienced guideline implementers: Attend to many factors and use multiple strategies.Joint Commission Journal of Quality Improvement. 2000,26:171–188.
Solberg LI: Guideline implementation: What the literature doesn’t tell us.Joint Commission Journal of Quality Improvement. 2000,26:525–537.
McAfee T: Waking the health plan giant: Group Health Cooperative stops counting sheep and starts counting key tobacco indicators.Tobacco Control. 2000,7:S41-S44.
Solberg LI: Incentivising, facilitating, and implementing an office tobacco cessation system.Tobacco Control. 2000,9(Suppl.1):37–41.
Hollis J, Lichtenstein E, Vogt T, Stevens VJ, Biglan A: Nurse-assisted counseling for smokers in primary care.Annals of Internal Medicine. 1993,118:521–525.
Hollis JF, Bills R, Whitlock E, et al.: Implementing tobacco interventions in the real world of managed care.Tobacco Control. 2000,9(Suppl. 1):18–24.
Solberg LI, Kottke TE, Brekke ML, et al.: Failure of a continuous quality improvement intervention to increase the delivery of preventive services: A randomized trial.Effective Clinical Practice. 2000,3:105–115.
Spencer E, Swanton T, Hueston WJ, Edberg D: Tools to improve documentation of smoking status: Continuous quality improvement and electronic medical records.Archives of Family Medicine. 1999,8:18–22.
Cabana MD, Rand CS, Powe NR, et al.: Why don’t physicians follow clinical practice guidelines? A framework for improvement.Journal of the American Medical Association. 1999,282:1458–1465.
Curry SJ, Grothaus LC, McAfee T, Pabiniak C: Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization.New England Journal of Medicine. 1998,339:673–679.
Schauffler HH, McMenamin S, Olson K, et al.: Variations intreatment benefits influence smoking cessation: Results of aran-domized controlled trial.Tobacco Control. 2001,10:175–180.
Boyel RG, Solberg LI, Magnan S, Davidson G, Alesci N: Does insurance coverage for drug therapy affect smoking cessation?Health Affairs. 2002,21:162–168.
Doescher MP, Whinston MA, Goo A, et al.: Pilot study of enhanced tobacco-cessation services coverage for low-income smokers.Nicotine and Tobacco Research. 2002,4:19–24.
Latts LM, Prochazka AV, Salas NM, Young DA: Smoking cessation in pregnancy: Failure of an HMO pilot project to improve guideline implementation.Nicotine and Tobacco Research. 2002,4:25–30.
Roski J, Jeddeloh R, An L, et al.: The impact of financial incentives and apatient registry on preventive care quality and increasing provider adherence to evidence-based smoking cessation practice guidelines.Preventive Medicine. 2003,36:291–299.
Swartz SH, Cowan TM, DePue J, Goldstein MG: Academic profiling of tobacco-related performance measures in primary care.Nicotine and Tobacco Research. 2002,4:38–44.
Andrews JO, Tingen MS, Waller JL, Harper RJ: Provider feedback improves compliance with AHCPR smoking cessation guidelines.Preventive Medicine. 2001,33:415–421.
Kiefe CI, Allison JJ, Williams OD, et al.: Improving quality improvement using achievable benchmarks for physician feedback: A randomized controlled trial.Journal of the American Medical Association. 2001,285:2871–2879.
Bentz CJ, Davis N, Bayley B: The feasibility of paper-based tracking codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an individual practice association (IPA) model health maintenance organization (HMO).Nicotine and Tobacco Research. 2002,4:9–17.
McAfee T, Grossman R, Dacey S, McClure J: Capturing tobacco status using an automated billing system: Steps toward a tobacco registry.Nicotine and Tobacco Research. 2002,4:31–37.
Klevan DH, Rolnick SJ, Talarico B: Interventions to implement a clinic-based smoking cessation guideline within a staff model HMO.Journal of Addictive Diseases. 1999,18:21–26.
Author information
Authors and Affiliations
Additional information
This research was supported by grants from the Tobacco-Related Disease Research Program (Taylor) and from the Robert Wood Johnson Foundation (Taylor and Curry).
About this article
Cite this article
Taylor, C.B., Curry, S.J. Implementation of Evidence-Based Tobacco Use Cessation Guidelines in Managed Care Organizations. ann. behav. med. 27, 13–21 (2004). https://doi.org/10.1207/s15324796abm2701_3
Issue Date:
DOI: https://doi.org/10.1207/s15324796abm2701_3