Survey of Providers' Attitudes Toward Integrating Smoking Cessation Treatment Into Posttraumatic Stress Disorder Care

Psychology of Addictive Behaviors (Impact Factor: 2.09). 05/2012; 27(1). DOI: 10.1037/a0028484
Source: PubMed


A survey was administered anonymously to 45 mental health providers who delivered smoking cessation treatment integrated into posttraumatic stress disorder care (integrated care) as part of a multisite clinical trial. Survey items assessed key factors associated with successful implementation of research-based practices from the perspective of treating providers. Factors assessed included prior experiences with cessation treatment, compatibility of integrated care with current practices, feasibility of adopting integrated care into regular practice, and adequacy of training. More than half of respondents reported that integrated care delivery was feasible, and they would be considerably or extremely likely to continue delivery in routine practice. Positive prestudy beliefs and more experience delivering cessation care were associated with stronger endorsement of delivering integrated care after the study. The most frequently cited obstacle to delivering integrated care involved time limitations. Future efforts should focus on developing treatment adaptations that address provider-identified barriers and identifying clinic- and administrative-level supports that facilitate delivery of integrated care and assist providers who incorporate integrated care into clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

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    ABSTRACT: Objectives: We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation. Methods: We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers' perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data. Results: More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n=52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC. Conclusions: The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.
    American Journal of Public Health 10/2014; 104(10):1935-1942. DOI:10.2105/AJPH.2013.301776 · 4.55 Impact Factor
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    ABSTRACT: Background Smoking remains the leading cause of preventable illness and mortality in the United States. Individuals with Posttraumatic Stress Disorder (PTSD) have smoking rates higher than that of others and fewer individuals with PTSD have quit smoking. This randomized controlled trial was designed to test the effectiveness of integrating telehealth care management and smoking cessation with motivational interview for Veterans with PTSD.Methods/designAll smokers with PTSD, regardless of their desire to quit, were invited to participate. Enrollment occurred between November 2009 and April 2013.Target enrollment was 120 participants. Enrolled participants were randomized to either the control group, receiving usual care including a telehealth PTSD program, with a device that delivered PTSD information and in-home care management, or the intervention group, which included (1) a telehealth PTSD program, (2) motivational interviewing-based smoking cessation curricula via the telehealth device, and (3) weekly motivational interviewing counseling phone calls. Outcomes are self-reported 24-hour quit attempts, progression along the stages of change and 7-day point prevalence quit smoking rates for the intervention group compared to usual care alone. Secondary outcomes include participants¿ perception of care coordination, patient satisfaction with motivational interviewing, PTSD symptoms, pain, depression and quality of life.DiscussionMotivational interviewing has been shown to increase readiness for change and smoking cessation care has been shown to be more successful when incorporated into in-person mental health care. Our study builds on previous studies. It integrates a written smoking cessation curriculum and phone-based motivational interviewing counseling into an established PTSD home telehealth care coordination program. This paper describes the design and methods of our randomized control trial.Trial, NCT00908882, May 22, 2009.
    BMC Health Services Research 02/2015; 15(1):46. DOI:10.1186/s12913-015-0706-6 · 1.71 Impact Factor