Tobacco-Focused Patient Navigation to Address Barriers to Smoking Cessation Service Utilization in Primary Care
Erica Lubetkin, MD, MPH and Jamie S. Ostroff, PhD
Decades of well-designed research have yielded numerous safe and efficacious tobacco cessation treatments, yet these evidence-based treatments are regrettably under-utilized, particularly among low income, minority smokers. We propose that by helping patients to access the healthcare system and overcome barriers to quality care, patient navigators are uniquely positioned to address the high priority need for coordinated cessation services. This project seeks to extend prior work in the area of patient navigation to design, implement and provide preliminary data on the impact and barriers of integrating tobacco cessation-patient navigation in primary care clinics that serve a low-income, minority population. With input from an expert panel of tobacco cessation colleagues, we will develop a tobacco-focused patient navigation training curriculum. We will then field test this tobacco focused patient navigation program using an interrupted time series design implemented with four primary care practices and evaluate the program using the RE-AIM framework. Our primary goal is to increase linkage of low-income, minority smokers to a menu of EXISTING evidence based tobacco cessation services including the New York State Quitline and other community-based cessation services. Secondary outcomes include 7 day point prevalence measured at 1 and 3 months following smokers’ initial contact with the navigator. The specific aims are to: 1) Develop a tobacco specific curriculum for training tobacco-focused patient navigators to increase the uptake of tobacco cessation services among smokers advised to quit smoking by their primary care physicians and 2) Pilot field test a tobacco-focused, patient navigation intervention for low income, minority smokers and use the RE-AIM evaluation framework to obtain preliminary data on its potential in terms of reach, effectiveness, adoption, implementation and maintenance. For the field testing, we will recruit 720 smokers from four primary care practices (180 each) that serve a low income, urban minority population. These providers will be trained in the PHS tobacco assessment guidelines and will refer smokers to the patient navigator, who will initiate a proactive phone call to the patient. In-person or via the telephone, the navigator will employ a Motivational Interviewing style to identify the patient’s environmental and intrapersonal barriers to adhering to physician cessation recommendations and will encourage the patient’s use of evidence-based cessation services in the community. To our knowledge, this project is the first effort to examine whether patient navigators can provide a much-needed culturally competent link in the chain connecting provider cessation advice to utilization of available community-based tobacco treatment services. The proposed research is significant because the results will advance our understanding of Patient Navigation by focusing on how the model functions in a real-world setting with representative patients and practice settings. This knowledge will guide the dissemination of Patient Navigation to reduce racial, ethnic and poverty-related disparities in tobacco-related morbidity and mortality.
Lubetkin EI, Lu W, Krebs P, Yeung H, Ostroff JS, (2010) Exploring primary care providers' interest using patient navigators to assist in the delivery of tobacco cessation treatment to low income, ethnic/racial minority patients. J Community Health, Epub ahead of print. PMID 20336355
Lubetkin EI, Lu WH, Krebs P, Yeung H, Ostroff JS. Tobacco Cessation Attitudes and Practices of Primary Care Providers Serving Low-Income, Racial/Ethnic Minority Patients. 2009, November: American Public Health Association (APHA) Annual Meeting.
Yeung H, Lubetkin EI, Lu WH, Krebs P, Ostroff JS. Tobacco Cessation Attitudes and Practices of Primary Care Providers Serving Low-Income, Racial/Ethnic Minority Patients. 2009, November: Annual Biomedical Research Conference for Minority Students (ABRCMS).
Krebs P, Ostroff JS, Yeung H, Lu WH, Lubetkin EI.Perceived Benefit of Using Patient Navigation to Assist Primary Care Providers in Delivering Tobacco Cessation Treatment to Low-Income, Racial/Ethnic Minority Patients. 2010, February: Society for Research on Nicotine and Tobacco Annual Meeting.