Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial

BMC Psychiatry. 2017 Feb 7;17(1):56. doi: 10.1186/s12888-017-1220-7.

Abstract

Background: Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities.

Methods: We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods.

Results: The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14).

Conclusions: This is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines.

Keywords: Clinical practice nursing research; Clinical trial; Health plan implementation; Health planning guidelines; Healthcare systems; Interrupted time series analysis; Psychiatric department, hospital; Psychiatric nursing; Smoking; Tobacco use disorder.

MeSH terms

  • Adult
  • Female
  • Hospitals, Psychiatric / organization & administration*
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • New South Wales
  • Outcome Assessment, Health Care
  • Patient Discharge / statistics & numerical data
  • Prevalence
  • Smoking / epidemiology
  • Smoking / psychology
  • Smoking / therapy*
  • Smoking Cessation / methods*
  • Smoking Cessation / psychology
  • Tobacco Use Disorder / epidemiology
  • Tobacco Use Disorder / psychology
  • Tobacco Use Disorder / therapy*