Reducing Tobacco Use and Secondhand Smoke Exposure: Provider Assessment and Feedback – Inactive

Inactive Community Guide Review

The reviews and findings listed on this page are inactive. Inactive reviews and findings are not scheduled for an update at this time, though they may be updated in the future. Findings become inactive when reviewed interventions are no longer commonly used, when other organizations begin systematically reviewing the interventions, or as a result of conflicting priorities within a topic area.

Summary of CPSTF Finding

The Community Preventive Services Task Force finds insufficient evidence to assess the effectiveness of provider feedback when used alone or in combination with other interventions because of the small number of studies and an insufficient number of studies providing measurements of changes in provider advice to quit or measurements of changes in client tobacco use cessation.

Intervention

Provider assessment and feedback interventions are intended to inform and motivate providers by (1) assessing how well they identify client tobacco use status, deliver advice to quit, or both, and (2) providing feedback on their performance. To do this, chart reviews or computerized records may be used. Assessment and feedback interventions can be combined with other activities, such as provider reminders and provider education.

CPSTF Finding and Rationale Statement

Read the Task Force Finding [PDF – 394 kB].

About The Systematic Review

Three studies qualified for the review. None of the qualifying studies measured changes in provider delivery of advice to quit or client tobacco use behaviors.

These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure.

Context

There is no information for this section.

Summary of Results

Content is in development.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

What are Evidence Gaps?

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Effectiveness

The effectiveness of recommended and strongly recommended interventions in this section (i.e., multicomponent provider reminder plus provider education with or without patient education materials; provider reminder systems alone; multicomponent interventions that include telephone cessation support; and reduction of patient out-of-pocket costs for cessation) is established. However, research issues regarding the effectiveness of these interventions remain.

  • Which characteristics of provider-based interventions contribute to increased or decreased effectiveness?
  • What are the least and most effective combinations of services in multicomponent interventions?
  • What is the effect of provider reminder systems on patient tobacco use cessation when implemented alone?
  • What is the relative effectiveness of provider reminders that focus on determination of patient tobacco use status versus reminders that prompt for delivery of advice to quit?
  • How do content and method of delivery of provider reminders relate to effectiveness?
  • Can reducing patient costs for effective cessation services increase the effectiveness of provider-based interventions?
  • What is the most effective level of implementation for telephone cessation support services?
  • Is the use and effectiveness of telephone cessation support increased when community and clinical cessation support programs are coordinated? Because the effectiveness of two interventions (provider education when used alone and provider feedback systems) has not been established, basic research questions remain. This is especially true for provider assessment and feedback systems for which the number of available studies was small.

Because the effectiveness of two interventions (provider education when used alone and provider feedback systems) has not been established, basic research questions remain. This is especially true for provider assessment and feedback systems for which the number of available studies was small.

  • What are the effects of provider assessment and feedback interventions on provider delivery of advice to quit to tobacco-using patients? On patient tobacco use cessation?
  • What is the effectiveness of HEDIS, as a form of assessment, feedback, and benchmarking, in improving patient receipt of advice to quit and patient tobacco use cessation? Does effectiveness vary by practice setting?
  • What frequency, duration, and format of provider education efforts are required to obtain consistent improvements in provider performance and patient response?

Applicability

Each recommended and strongly recommended provider-based intervention should be applicable in most relevant target populations and settings. However, possible differences in the effectiveness of each intervention for specific subgroups of patient and provider populations could not be determined. Several questions regarding the applicability of these interventions in settings and populations other than those studied remain.

  • Do provider-based interventions differ in effectiveness in different patient populations?
  • Are provider-based interventions effective in increasing cessation or in reducing initiation in adolescent populations?
  • Do significant differences exist regarding the effectiveness of these interventions, based on the level of scale at which they are delivered?

Other Positive or Negative Effects

With the exception of the use of provider reminder systems to prompt action on other preventive services, studies in this review did not report on other positive and negative effects of these interventions. Research on the following questions would be useful:

  • Do provider-based interventions for tobacco use cessation interfere with office flow or efficiency? If so, how can this effect be minimized?
  • Do provider-based interventions increase or decrease the delivery of other preventive services?

Economic Evaluation

Available economic information was limited in this section. Considerable research is warranted regarding the following questions:

  • What are the costs for provider-based interventions?
  • What are the costs for patient-based interventions?
  • How do the costs per additional quitter compare with other interventions intended to reduce tobacco use?
  • What is the cost-benefit, cost-utility, or the cost per illness averted of these interventions?
  • What is the cost-effectiveness for provider interventions that target tobacco alone compared with provider interventions that target multiple preventive services?

Barriers

Research questions regarding the potential barriers identified for the interventions evaluated in this section include the following:

  • How can provider-based interventions that place minimal administrative burden on providers or systems be implemented?
  • What information is needed to overcome potential barriers to the implementation of provider assessment and feedback interventions?
  • What information is needed to overcome potential barriers to reducing patient out-of-pocket costs for effective cessation therapies?
  • What is the effect on use of combining effective pharmacologic therapies and behavioral programs as a criterion for reimbursement? What is the effect on use and effectiveness if these cessation options are provided independently?

Study Characteristics

No content is available for this section.

Publications

Hopkins D, 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(2S):16-66.

Task Force on Community Services. Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine 2001;20(2S):10-5.

Centers for Disease Control and Prevention. Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health-care systems. A report on recommendations of the Task Force on Community Preventive. MMWR 2000;49(RR-12): 1-11. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4912a1.htm.

Curry SJ, Fiore MC, Burns ME. Community-level tobacco interventions: perspective of managed care. American Journal of Preventive Medicine 2001;20(2S):6-7.

Satcher D. Forward: note from the Surgeon General. American Journal of Preventive Medicine 2001;20(2S):1.

Warner KE. Tobacco control policy: from action to evidence and back again. American Journal of Preventive Medicine 2001;20(2S):2-5.

Wasserman MP. Guide to community preventive services: state and local opportunities for tobacco use reduction. American Journal of Preventive Medicine 2001;20(2S):8-9.

Task Force on Community Services, Zaza S, Briss PA, Harris KW. Tobacco. In: The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press; 2005:3-79.

Analytic Framework

No content is available for this section.

Summary Evidence Table

No content is available for this section.

Included Studies

Bonevski B, Sanson-Fisher RW, Campbell E, Carruthers A, Reid AL, Ireland M. Randomized controlled trial of a computer strategy to increase general practitioner preventive care. Preventive Medicine 1999;29:478-86.

Kern D, Harris W. Use of an outpatient medical record audit to achieve educational objectives. J Gen Intern Med 1990;5:218-24.

Shank J, Powell T, Llewelyn J. A Five-year Demonstration Project Association with Improvement in Physician Health Maintenance Behavior. Family Medicine 1989;21:273-8.

Additional Materials

There is no information for this section.

Search Strategies

No content is available for this section.

Review References

There is no information for this section.

Considerations for Implementation

The Task Force did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.