The 5As Model for Smoking Cessation: Engaging Health Care Providers and Overcoming Barriers to Change

Abstract

<p>The purpose of this DNP project was to improve provider utilization of the 5As model for smoking cessation (asking, advising, assessing, assisting and arranging for follow up) for patients who smoke with every patient encounter and to increase smoking cessation rates in a primary care practice located in a northern suburb of Chicago. The practice provided care for a birth through elderly patient population. There were three providers in this practice who participated in the project; one family physician and two nurse practitioners. The project leader, one of the nurse practitioners in the practice, met with the providers at the start of the project to discuss barriers to providing smoking cessation counseling in the setting and potential ways to reduce the barriers. A power point educational presentation on the 5As model and smoking cessation was presented to each of the providers. The electronic medical record (EMR) was modified to add the 5As. Medical assistants were included as part of the team in implementing the practice change.</p> <p>A descriptive study design was utilized to evaluate the effectiveness of provider education and EMR modification in increasing smoking cessation counseling using the 5As model and smoking cessation rates or statement of intent to quit. The project leader conducted chart audits of patients seen 3 months prior and 3 months after the change was implemented. The chart audit results indicated an improvement in providers assessing, assisting, and arranging for follow-up for patients who smoke with every patient encounter. Limitations in the study of outcomes for this practice improvement project included the small number of participants/providers, limited project time frame, and inability to generalize results.</p> <p>Integration of the 5As model into the EMR system was effective in this primary care setting to reduce provider barriers, improve provider utilization of the 5As, and improve patient smoking cessation rates. The process of change requires assessment and reduction of barriers, communication, defined roles, and teamwork.</p> <p> </p>