Clinical system elements and patient reports of tobacco cessation counseling

• Objective: To assess clinical systems and staff perceptions of the quality environment related to tobacco treatment and patient receipt of services in actual practice. • Methods: Clinical systems related to tobacco treatment were assessed by direct examination of clinic documents at 130 primary care clinics within the 30 largest health systems in Minnesota. A staff survey assessed perceptions of the clinic's quality environment (eg, presence of goals, feedback, and a champion). Patients' smoking status and receipt of tobacco treatment was assessed by patient exit survey. • Results: Of smokers surveyed, 77% reported being asked about tobacco use, 62% reported receiving an offer of some form of assistance, and 13% reported that some follow-up was arranged. Twenty-three percent of smokers reported that they did not discuss tobacco use with any health care professional. The patient's level of treatment varied significantly (P < 0.05) by clinic specialty, clinic organization, and the presence of more developed clinical systems supporting tobacco treatment. Staff ratings of the quality environment were low (mean, 1.72 out of 5 possible elements) and not associated with patients' receipt of tobacco treatment. • Conclusions: Our study finds that national guidelines are best implemented by well-developed clinical systems that support physicians and clinical staff in providing tobacco treatment. Efforts to improve tobacco treatment should focus on addressing completeness of clinical systems and fragmentation of the quality environment.