Background: Tobacco use has a negative impact on oral health. Practice guidelines encourage dental providers to provide tobacco using patients with cessation counseling. In order to improve adherence to these guidelines, it is important to understand the factors that make implementation difficult. As part of a clinical trial testing a clinical decision support tool to support guideline compliance in dental practice, we examined baseline factors that could serve as barriers to guideline implementation.
Methods: We enrolled 29 dental providers into a tobacco cessation trial. At baseline we administered a questionnaire based on key theoretical domains relevant to implementation behaviors of health care providers. The online baseline survey was collected from 10 dentists and 19 hygienists at 10 private practice dental offices from July 2019 to August 2020. Descriptive statistics compare endorsement of individual survey items (response scale: 1 = strongly disagree, 5 = strongly agree) and patterns of differences in dentist and hygienist responses are described.
Results: Clinicians believe there is value in (mean: 4.1), and that their role includes provision of (mean=4.3) tobacco cessation services. Hygienists were directionally more likely than dentists to agree that their role involved assisting patients to stop tobacco use (means: 4.6 vs 4.0). Clinicians had a moderate level of confidence in how to assess patients in efforts to stop tobacco use (mean: 3.5) and that they knew the right questions to ask patients (mean: 3.2). Clinicians were less confident in prescribing medications for those ready to quit (mean: 1.9) and had moderate levels of understanding the risks and benefits of nicotine replacement therapy (mean: 2.8). Clinicians lack a system to cue/prompt counseling against tobacco use (mean: 2.1) and report that clinics had done little to remove barriers to the provision of tobacco use counseling (mean: 2.3). Directional differences in dentist vs hygienist item means indicated that receipt of sufficient reimbursement for promoting tobacco abstinence was more of a concern for dentists than hygienists (means: 2.4 vs 3.6).
Conclusion: Dental providers believe they have a valuable role in tobacco cessation. Opportunities to enhance tobacco cessation include providing tools to prompt counseling and assist prescribing medications. Dentists more than hygienists
identify reimbursement as insufficient. More could be done to remove barriers.