Increases in delivery of a brief smoking cessation intervention following implementation of a system change intervention in community psychiatry settings

Objective: Tobacco-related disease is a leading cause of premature mortality for people experiencing mental illness. Tobacco treatment is not routinely provided in psychiatry with systemic barriers preventing access to treatment. This study examines a system change approach, with an incentive payment, to implement tobacco treatment at scale in community psychiatry settings. Methods: Secondary analysis of statewide health administrative data was conducted. Changes in documentation of smoking status and delivery of a tobacco treatment brief intervention (the Pathway) were evaluated using interrupted time series analysis between July 2017 and June 2023. An implementation period (4 years), divided into incentive payment phases for achievement of pre-defined targets, and a post-incentive payment maintenance period (2 years) were defined. Results: Documented average smoking rate for community psychiatry during maintenance remained high (52.5%; 95% confidence interval = [52.5, 52.6]). Statewide documentation of smoking status significantly exceeded targets during implementation, reaching 93.9% (95% confidence interval = [93.3%, 94.4%]). Despite a 2.1% decrease (95% confidence interval = [−3.4, −0.8]) after removal of incentive payments, reporting remained high 91.9% (95% confidence interval = [91.5%, 92.3%]). Documentation of the Pathway was significantly higher than targets and showed no change by implementation end (87.0%; 95% confidence interval = [85.9%, 88.1%]) to maintenance where no incentive payments were available (85.7%; 95% confidence interval = [84.9%, 86.5%]). Conclusions: Delivery of tobacco treatment in psychiatry is an important step to addressing inequity in smoking prevalence, but achieving this has been challenging. Our study demonstrates the potential of a system change intervention to improve care and sustainably deliver tobacco cessation treatment, at scale, in psychiatry settings.