Dissertation Research Support: Health System Processes Clinician Attitudes, and Referrals to Tobacco Treatment Programs

Tobacco dependence is a major public health problem in the state of Kentucky. Kentucky leads the nation by having 7,800 tobacco related cancer deaths annually and is among the top three states in adult smoking rates. Improved access to evidence based, comprehensive treatments for tobacco dependence is needed to help prevent tobacco related deaths. Tobacco dependence is a chronic, relapsing condition that is often resistant to treatment in primary care practice. Comprehensive tobacco dependence in primary care includes assistance with a referral to cessation counseling. Participation in cessation counseling significantly increases the likelihood that the smoker will quit and avoid relapse. Despite clear evidence of the efficacy of cessation programs clinicians infrequently assist their patients with a referral to cessation programs and patient participation is low. Barriers to cessation program access include clinician attitudes and lack of health system processes to facilitate referrals. The purpose of this study is to examine relationships between health system processes to facilitate referrals, clinician attitudes, and rate of referrals to tobacco treatment counseling programs. This study is guided by Self-determination Theory and utilizes a descriptive, correlational research design. Cross-sectional data from self-administered surveys from a sample of physicians, advanced registered nurse practioners and physician assistants (clinicians) practicing in the state of Kentucky will be utilized to assess self-reported rates of clinician referrals, presence of health system factors to facilitate referrals, and clinician attitudes about tobacco treatment. Predictors of rate of referral will be determined using multiple linear regression.