This project tested the feasibility of using academic detailing to facilitate system changes to increase tobacco cessation counseling in dental offices in four Northeastern states.  Academic detailing consists of attempting to change provider’s behaviors in their practice by face-to-face interactions and has been shown to have strong effects on behavior.  Dental providers have the lowest rates of cessation services when compared with other health care providers; however, 95% of dental providers are willing to receive training.  Dental providers represent an untapped resource for providing smokers with cessation services.

Eighty-eight of the 507 dental offices contacted agreed to participate; offices were randomly divided into control and intervention groups.  Participating dental offices in the intervention group received a one-hour education program on providing tobacco cessation intervention for all staff.  A dental hygienist detailer followed-up the training with three short monthly visits, that reinforced the continuing education sessions.  After receiving the intervention, dental offices asked all patients to complete a survey regarding tobacco use.  Dental providers were also asked to flag tobacco users in patient records.  Flagged patients received a monthly package containing self-help and support materials for tobacco cessation.

Prior to intervention, dentists were surveyed about their knowledge, attitudes, and behaviors regarding smoking cessation.  The survey indicated that dentists explained their unwillingness to provide cessation because of lack of training and financial incentives.  Dentists were also concerned about the time requirement for counseling and the suspected resistance by the patients.

Initially there was resistance to academic detailing in the intervention group.  Barriers reported by the dentists included lack of knowledge, the assumption that few patients were tobacco users, and concern that patients would be uncooperative.  With regular contact, reinforcement, and repetition, dental providers became more knowledgeable about tobacco cessation, and were more able and willing to counsel patients. 

Twelve months after initiation of the intervention, participating dentists were more likely to discuss setting a specific quit date for patients interested in quitting, were more likely to discuss specific strategies for quitting, were more likely to provide advice about the use of nicotine gum, and were more likely to refer patients to cessation clinics or programs. 

With ongoing support and training to their dental providers, academic detailing can be an effective way to approach cessation services for tobacco users. It can be a costly intervention, so implementation needs to be carefully planned to facilitate its success. 

Citations:

Albert D, Ahluwalia K, Ward A, Sadowsky D.  The use of “academic detailing” to promote tobacco-use cessation counseling in dental offices.  Journal of American Dental Association, 2004; (130): 1700-1706. 

Albert D, Ward A, Ahluwalia K, Sadowsky D.  Addressing tobacco in managed care:  a survey of dentists’ knowledge, attitudes, and behaviors.  American Journal of Public Health, 2002; 92(6): 997-1001.