Performance Obligations to Improve Delivery of Hospital-Initiated Smoking Cessation Interventions: A Before-and-After Evaluation.

INTRODUCTION: This study evaluated whether introducing performance obligations (a policy intervention) to service agreements between hospitals (n = 15) and their local health authority: (1) improved provision of an evidence-based tobacco cessation intervention (the "Ottawa Model" for Smoking Cessation) and (2) changed the quality of the cessation intervention being delivered. METHODS: Interrupted time series analysis was used to evaluate the change in the proportion of smoker patients provided the Ottawa Model 3 years before and 3 years after introducing the performance obligations. Changes in secondary outcomes related to program quality were described using mean differences, risk differences, and risk ratios, as appropriate. RESULTS: The proportion and number of patients provided the Ottawa Model doubled in the 3-year period following introduction of the new policy-from 3453 patients (33.7%) in the year before to 6840 patients (62.8%) in the final assessment year. This resulted in a signification slope change (+9.2%; 95% confidence interval [CI] 4.5%, 13.9%; p = .01) between the pre- and post-obligation assessment periods, signifying the policy had a positive impact on performance. Quality and effectiveness of the in-hospital intervention remained steady. CONCLUSIONS: Implementation of performance obligations by a healthcare funder increased delivery of an evidence-based smoking cessation intervention across multiple hospitals. Given the known health and economic impacts of smoking cessation interventions, health authorities and hospitals should consider pairing adoption of systematic interventions, like the Ottawa Model, with policy to enhance reach and impact. IMPLICATIONS: • The hospital-based Ottawa Model for Smoking Cessation (OMSC) intervention has been shown to increase smoking abstinence, while reducing mortality and healthcare utilization.• The uptake of systematic, evidence-based interventions, like the OMSC, by hospitals has been relatively low despite the known positive impacts.• The introduction of smoking cessation performance obligations by a healthcare funder resulted in more patients receiving an OMSC intervention while in hospital, with no corresponding change in intervention quality or effectiveness.• Healthcare funders and hospitals should consider pairing the adoption of effective, systematic interventions, like the OMSC, with policy to enhance reach and impact.

Knowledge, attitudes and behaviours related to dietary sodium among 35- to 50-year-old Ontario residents.

BACKGROUND: Excessive consumption of dietary sodium is an important public health issue. Little is known about the knowledge, attitudes and behaviours related to sodium consumption among Canadians. OBJECTIVE: To examine knowledge, attitudes and behaviours related to sodium consumption among a sample of Canadians 35 to 50 years of age. METHODS: A random-digit-dial telephone survey was conducted among adults aged 35 to 50 years of age in two regions in Ontario. Logistic regression was used to examine the likelihood of having taken action in the past 30 days to reduce sodium consumption, and the likelihood that respondents were intending to reduce sodium in the next six months. RESULTS: A total of 3130 interviews were completed. The majority of respondents were aware of excessive sodium consumption as a health issue and reported that they were taking action to reduce their dietary sodium intake. A large proportion of respondents did not correctly identify many foods as being high in sodium and, consequently, may have incorrectly believed they were consuming healthy amounts of sodium. Respondents who believed sodium reduction was important were more likely to have taken action to reduce sodium within the previous 30 days. Respondents who self-identified as consuming too much sodium were less likely to have taken action. CONCLUSIONS: The findings of the present study suggest that in addition to policy changes designed to reduce the sodium content of foods, there is a need to address the low levels of knowledge surrounding sources of excessive sodium in popular Canadian foods, the importance of a reduced intake of sodium and the availability of lower-sodium alternatives.