• Diane Kunyk, Charl Els, Sophia Papadakis, and Peter Selby.
• Assistant Professor in the Faculty of Nursing, Adjunct Professor in the John Dossetor Health Ethics Centre, and Associate Researcher in the Centre for Effective Business Management of Addiction Treatment at the University of Alberta in Edmonton. diane.kunyk@ualberta.ca.
• Can Fam Physician. 2014 Jul 1; 60 (7): 646-55.

ObjectiveTo test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians.DesignA prospective cohort study.SettingSixty primary care sites in Alberta.ParticipantsA convenience sample of 198 primary care physicians from the population of 2857.Main Outcome MeasuresData collection occurred between September 2010 and February 2012 on 3 distinct measures. Twenty-four weeks after the intervention, audits of the primary care practices assessed the adoption and sustainability of 10 tobacco clinical system pathway components, a survey measured changes in physicians' treatment intentions, and patient chart reviews examined changes in physicians' consistency with the treatment algorithm.ResultsThe completion rate by physicians was 89.4%. An intention-to-treat approach was undertaken for statistical analysis. Intervention uptake was demonstrated by positive changes at 4 weeks in how many of the 10 clinical system measures were performed (mean [SD] = 4.22 [1.60] vs 8.57 [1.46]; P < .001). Physicians demonstrated significant favourable changes in 9 of the 12 measures of treatment intention (P < .05). The 18 282 chart reviews documented significant increases in 6 of the 8 algorithm components.ConclusionOur findings suggest that the provision of a tobacco clinical system pathway that incorporates other members of the health care team and builds on existing office infrastructures will support positive and sustainable changes in tobacco use disorder treatment by physicians in primary care. This study reaffirms the substantive and important role of supporting how treatment is delivered in physicians' practices.Copyright© the College of Family Physicians of Canada.

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