Using a multilevel implementation strategy to facilitate the screening and treatment of tobacco use in the outpatient urology clinic: A prospective hybrid type I study

Background Urologists frequently treat patients for tobacco‐related conditions but infrequently engage in evidence‐based practices (EBPs) that screen for and treat tobacco use. Improving the use of EBPs will help to identify smokers, promote cessation, and improve patients' health outcomes. Methods A prospective type I hybrid effectiveness‐implementation study was performed to test the feasibility and effectiveness of using a multilevel implementation strategy to improve the use of tobacco EBPs. All urology providers at outpatient urology clinics within the Veterans Health Administration Greater Los Angeles and all patients presenting for a new urology consultation were included. The primary outcome was whether a patient was screened for tobacco use at the time of consultation. Secondary outcomes included a patient's willingness to quit, chosen quit strategy, and subsequent engagement in quit attempts. Results In total, 5706 consecutive veterans were seen for a new consultation during the 30‐month study period. Thirty‐six percent of all visits were for a tobacco‐related urologic diagnosis. The percentage of visits that included tobacco use screening increased from 18% (before implementation) to 57% in the implementation phase and to 60% during the maintenance phase. There was significant provider‐level variation in adherence to screening. Of all screened patients, 38% were willing to quit, and most patients chose a “cold turkey” method; 22% of the patients elected referral to a formal smoking cessation clinic, and 24% chose telephone counseling. Among those willing to quit, 39% and 49% made a formal quit attempt by 3 and 6 months, respectively. Conclusions A strategy that includes provider education and a customized clinical decision support tool can facilitate provider use of tobacco EBPs in a surgery subspecialty clinic. Urologists frequently treat tobacco‐related conditions. The use of tobacco screening and treatment by providers in the urology clinic can be improved through the implementation of a multilevel intervention.