Academic Detailing Interventions Improve Tobacco Use Treatment among Physicians Working in Underserved Communities

Rationale: Tobacco use disproportionately affects the poor, who are, in turn, least likely to receive cessation treatment from providers. Providers caring for low-income populations perform simple components of tobacco use treatment (e.g., assessing tobacco use) with reasonable frequency. However, performance of complex treatment behaviors, such as pharmacologic prescription and followup arrangement, remains suboptimal. Objectives: Evaluate the influence of academic detailing (AD), a university-based, noncommercial, educational outreach intervention, on primary care physicians' complex treatment practice behaviors within an urban care setting. Methods: Trained academic detailers made in-person visits to targeted primary care practices, delivering verbal and written instruction emphasizing three key messages related to tobacco treatment Physicians' self-reported frequency of simple and complex treatment behaviors were assessed using a seven-item questionnaire, before and 2 months after AD. Results: Between May 2011 and March 2012, baseline AD visits were made to 217 physicians, 109 (50%) of whom also received follow-up AD. Mean frequency scores for complex behaviors increased significantly, from 2.63 to 2.92, corresponding to a clinically significant 30% increase in the number of respondents who endorsed "almost always" or "always" (P < 0.001). Improvement in mean simple behavior frequency scores was also noted (3.98 vs. 4.13; P = 0.035). Sex and practice type appear to influence reported complex behavior frequency at baseline, whereas only practice type influenced improvement in complex behavior scores at follow up. Conclusions: This study demonstrates the feasibility and potential effectiveness of a low-cost and highly disseminable intervention to improve clinician behavior in the context of treating nicotine dependence in underserved communities.