Health Systems Change for American Indian Clinics to Address Nicotine Addiction

Authors:

Meggan McCann (Presenter)
American Indian Cancer Foundation

Public Health Statement: The smoking rate among American Indians in Minnesota is 59%, compared to Minnesota’s overall smoking rate of 14.4%. To help address this extreme disparity, the American Indian Cancer Foundation has taken a strategy of working with American Indian clinics to implement evidence-based methods of treating nicotine addiction.

Purpose: The primary research question is what are the impacts of a multi-component tailored intervention, based on application of the evidence within the 2008 U.S. Public Health Service Clinical Guideline for Treating Tobacco Use and Dependence, on the use of cessation assistance and quit rates among patients served at a sample of American Indian health systems in Minnesota.

Methods/Approach: A convenience sample of 7 Minnesota American Indian clinics are participating in the study.

The research project uses multiple instrumentations to track clinic progress.

1. System assessments. Interdepartmental teams share current practices related to use of evidence-based practices for clinical cessation support (the 5 A’s of ask, advise, assess, assist, arrange).
2. Staff surveys. Surveys measure self-reported use of the 5 A’s.
3. EHR data reports on measures related to the 5 A’s.
4. Quality improvement team action plans.

Results: The study is ongoing and all results are preliminary. Data from a formative feasibility study have demonstrated the promise of a multicomponent systems-level intervention based on the 5 A’s method. Results from the current study include—

• Initial staff survey results showed low awareness of the 5 A’s.
• Results from the surveys were used to tailor trainings.
• EHR data reports have shown positive preliminary results in increasing use of cessation support services.
• QI show progress towards systems changes across clinics.

Conclusions/Implications: Implementing systems changes to support increased use of cessation services is a promising strategy for American Indian clinics. Using a highly customized and culturally relevant approach has allowed each clinic to take the approach most appropriate for their health system.