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Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
Deborah J Cohen1, Shannon M Sweeney2, William L Miller3
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon cohendj@ohsu.edu.
Annals of Family Medicine
|June 28, 2021
Summary
No single strategy improved smoking or blood pressure (BP) outcomes. Specific operational changes, tailored to practice size and ownership, alongside facilitation, drove improvements in primary care settings.
Area of Science:
- Primary Care Research
- Health Services Research
- Cardiovascular Disease Prevention
Background:
- Improving patient outcomes for smoking cessation and blood pressure (BP) control is crucial in primary care.
- EvidenceNOW initiative provided a platform to study cardiovascular disease prevention strategies.
Purpose of the Study:
- To identify operational changes and contextual factors associated with improved smoking and BP outcomes in primary care.
- To understand how practice characteristics influence the effectiveness of interventions.
Main Methods:
- Purposive sampling of staff from 104 primary care practices involved in EvidenceNOW.
- Analysis of Clinical Quality Measure improvements for smoking and BP control.
- Qualitative interviews to identify operational changes, converted to quantitative data.
- Configurational Comparative Methods to assess joint effects of multiple factors on outcomes.
Main Results:
- Clinician-owned practices showed improved smoking outcomes with routine screening/counseling workflows or documentation/referral changes, especially with moderate facilitation.
- BP outcomes improved in solo practices with accurate BP measurement training.
- Larger, clinician-owned practices saw BP improvements with a second BP measurement protocol and improved EHR documentation.
- Sufficient facilitation (≥50 hours) enhanced BP outcomes in larger and system-owned practices implementing operational changes.
Conclusions:
- No universal approach exists for enhancing smoking or BP outcomes.
- Improvements are context-dependent, influenced by practice ownership, size, and the extent of external facilitation.
- Tailored implementation strategies are necessary for optimizing cardiovascular risk reduction in primary care.
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