Dissemination Efforts—Clinical Practice and Community Preventive Services Guidelines
August 14, 2001: Smoking Cessation: Facing the Challenges of Tobacco Addiction
Christine Williams, Director, Office of Health Care Information, Agency for Healthcare Research and Quality, Rockville, Maryland
Ms. Williams began her presentation with a brief review of the background and history of the Public Health Service's Clinical Practice Guideline: Treating Tobacco Use and Dependence. The current guideline, published in 2000, is an update of the original 1996 AHCPR smoking cessation guideline, which incorporates the new evidence published since that time. While AHRQ created a successful dissemination partnership for the 1996 recommendations, the agency is currently placing a greater emphasis on the translation of research into practice for the PHS guideline.
Ms. Williams described a recent initiative, the PHS Tobacco Guidelines Collaboration, coordinated by AHRQ and the Centers for Tobacco Research and Intervention (CTRI), at the University of Wisconsin Medical School in Madison. The PHS Tobacco Guidelines Collaboration hopes to enhance the development, dissemination, and implementation of common tobacco cessation products for clinicians and patients. The goal is to minimize the overlap of products produced and the confusion that has been created with the recent influx of recommendations and guidelines for tobacco use treatment. The initiative will rely on partnerships between federal and non-federal organizations and agencies that will agree to base future documents and messages on the evidence-based recommendations from Treating Tobacco Use and Dependence and the Guide to Community Preventive Services. The recommendations from the two guidelines are very similar with the exception being the Guide to Community Preventive Services includes clinical and population-based recommendations, while the PHS Clinical Practice Guideline is focused on the clinical setting. Partners would also agree to pool resources and work together to provide technical assistance and financial expertise to develop implementation tools.
Ms. Williams concluded her remarks by providing a timetable for the establishment of the collaboration. Potential partners have been and will continue to be identified and a blueprint is currently being drafted that will outline the collaboration's mission, goals, and activities. Before finalizing, a working document of the blueprint is expected to be presented at the National Conference on Tobacco or Health in November 2001.
Bradford A. Myers, Dissemination Coordinator, Community Guide Branch, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Mr. Myers began with a brief overview of the Guide to Community Preventive Services. Staffed by CDC, an independent Task Force on Community Preventive Services conducted a systematic review of available literature on tobacco use prevention looking at effectiveness and economic efficiency information. The result was a series of clinical and population-based recommendations focused on reducing tobacco use and exposure to environmental tobacco smoke. The recommendations described by Mr. Myers focus on strategies that can be applied at the health care system, policy or community level. In terms of furthering the resources available to promote tobacco cessation and reduce initiation, Mr. Myers noted that population-based recommendations like those from the Task Force are essential to enhancing the impact of proven clinical strategies. For example, data indicate that 70% of smokers want to quit, but only half of these smokers are being advised to quit by their physicians. If we know that provider counseling on tobacco use is an effective strategy, then how you ensure that provider counseling is done is a question that is answered by population-based strategies like provider reminder systems. Linking clinical and community strategies increases the range and effectiveness of each. These recommendations provide a tool for informed decision making for practitioners, policymakers, and researchers who can not only use the recommendations as a standard reference for effectiveness information, but will also hopefully incorporate the evidence base into program and policy decisions.
Moving to the issue of dissemination, Mr. Myers briefly commented on the PHS Collaborative that was previously described by Ms. Williams and he reiterated that this initiative would help people better understand the relative advantage of each of the guidelines that has recently been issued. Mr. Myers also mentioned the creation of an online matrix that is currently under development that would help people better understand the Community Guide in the context of other recommendations. Finally, Mr. Myers talked about a series of workshops for state decision makers that is currently in development by the CDC's Office on Smoking and Health and Community Guide staff. The purpose of the workshops is to help participants understand the recommendations and resources and how they can be translated into program and policy decisions.
Following the presentations by Ms. Williams and Mr. Myers, Dr. Satcher asked about the best approach to educating physicians about evidence-based recommendations given the shortage of time they have to review such information. Mr. Myers responded by saying that instead of trying to reach individual physicians, they have made an effort to work closely with professional groups such as the American Medical Association and health maintenance organizations such as Kaiser Permanente to ensure that these groups communicate the information to their membership. Ms. Williams also reminded the group that other health professionals such as nurses and physician assistants should be included in these educational efforts. Dr. Satcher asked a follow-up question about research that confirms that other health professionals are equally capable of delivering cessation services, and Dr. Husten responded that there is research to confirm the effectiveness of a team approach to tobacco use treatment.
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