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Reaching Underserved Smokers through a Community Practice-Based Research Award

A funding opportunity to support quit attempts and systems change in community health and behavioral health clinics serving California’s Medi-Cal patient population with high rates of tobacco use

Tobacco use rates and tobacco-related diseases remain disproportionately high among California’s Medi-Cal patient population. Patients receiving Medi-Cal who use tobacco are demographically, ethnically, and culturally diverse. The primary care and behavioral health clinical settings, where Medi-Cal patients access care, represent key opportunities to address tobacco use.  Many clinics serving a majority of Medi-Cal patients in the community experience high patient loads, but have restricted access to medical resources necessary to address complex health problems managed by smokers. Among many behavioral health providers serving this patient population, social norms exist that quitting tobacco use is the least important healthcare problem to address among their multiple, complex health issues.

TRDRP has launched a Community Practice-Based Research (CPBR) initiative to promote partnerships between academic researchers and healthcare practitioner leaders to collaborate on health service research that informs best practices for systems change for treating tobacco use in clinics serving Medi-Cal patients. The initiative involves researchers and healthcare providers, staff, and administrators actively engaging in research to:

  • improve access to and delivery of tobacco cessation services for Medi-Cal patients (encourage quit attempts and continuous abstinence),
  • foster buy-in and social norm change among community providers around the importance of addressing tobacco use in this patient population, and
  • broadly disseminate findings tested for generalizability, scalability, and cost effectiveness in primary care and behavioral health settings.

The CPBR initiative is intended to support long-term collaborative relationships between academic researchers and healthcare practitioners working in diverse clinical settings. Efficacious and generalizable tobacco interventions are highly needed across clinical specialties serving diverse patient populations who are low-income and smoke at alarmingly high rates.

TRDRP funded two CPBR planning phase grants in July 2016 to begin to address this complex need. Planning phase awards are intended to provide resources to build and strengthen collaborative partnerships between researchers and providers, overcome barriers and approvals necessary to conduct health service research, and to build a consortium of clinics that engage in the same research project(s) across clinical services and locations to address generalizability and sustainability issues. The first grant was awarded to Joseph Guydish, PhD (UCSF), Maya Vijayaraghavan, PhD (UCSF), & Ana Valdes, MD (San Francisco Health Right 360) and focuses on policy change in addiction treatment and elucidating barriers and facilitators to delivering evidence-based tobacco treatments in primary care clinics. The second planning phase grant was awarded to Elisa Tong, MD (UC Davis), Susan Stewart, PhD (UC Davis), & Hal Yee, Jr., MD, PhD (Los Angeles County Department of Health Services) and focuses on improving provider electronic consults to the CA Smokers’ Helpline and patient-provider communications on barriers and facilitators to accessing free smoking cessation counseling. Both projects are in the very early stage of development.

TRDRP plans to continue offering the CPBR planning phase grants in our July 2017 Call for Applications, and plans are underway to issue an Implementation Phase CPBR grant mechanism this summer. The implementation phase of funding will involve a scaling up of research activity based on preliminary data and promising findings, and the addition of more clinic sites serving Med-Cal patients to the consortium.

As part of this initiative, TRDRP will solicit feedback and recommendations from an External Stakeholder Advisory Board (ESAB) that includes county, state, and national leaders in healthcare administration, healthcare delivery, and expertise implementing practice-based policies for Medi-Cal patients. Thus far appointments include representatives of the California Department of Health Care Services (DHCS), the California Department of Public Health (CDPH), the Agency for Healthcare Research and Quality (AHRQ), and the American Cancer Society. The ESAB’s role will be to guide TRDRP and funded investigators in identifying metrics and research evidence that could be considered best practices for policy change within health care departments and managed care systems across the state, and to provide guidance on issues related to the scalability, generalizability, and changes to health insurance programs. The California DHCS is very interested in lessons learned from the health service research projects funded by TRDRP and will assist investigators and the Program to disseminate best practices widely to benefit cessation efforts of underserved Californians who are tobacco smokers, and accelerate social norm change in the field so that all healthcare workers recognize the importance of tobacco cessation regardless of their patients’ background.

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