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Randomized Controlled Trial
. 2018 Nov;16(6):498-506.
doi: 10.1370/afm.2312.

From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates

Sophia Papadakis  1   2   3 , Adam G Cole  4 , Robert D Reid  5   2 , Roxane Assi  5 , Marie Gharib  5 , Heather E Tulloch  5 , Kerri-Anne Mullen  5 , George Wells  2   6 , Andrew L Pipe  5   2
Affiliations
Randomized Controlled Trial

From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates

Sophia Papadakis et al. Ann Fam Med. 2018 Nov.

Abstract

Purpose: The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians.

Methods: In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (Ask, Advise, Assist, Arrange) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up.

Results: Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for Ask (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), Assist (AOR = 1.64; 95% CI, 1.08-2.49), and Arrange (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for Advise was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; P = .02). No differences were documented between groups for cessation outcomes.

Conclusions: Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.

Keywords: Ottawa Model for Smoking Cessation; audit and feedback; coaching; knowledge translation; primary care; quality improvement; randomized controlled trial; smoking cessation.

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Figures

Figure 1
Figure 1
Randomized controlled trial study design. OMSC = Ottawa Model for Smoking Cessation.
Figure 2
Figure 2
Clinician performance in tobacco-dependence treatment delivery at pre- and postassessment in the intervention group according to clinic baseline performance. Note: Low-performing clinics had a baseline rate of Advise <40.5%; high-performing clinics had a baseline rate of Advise ≥40.5%.
See this image and copyright information in PMC

References

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