Table 2 Results

Domain 5. Train and educate stakeholders

  Mullins, 1999 [70]

Victoria, Australia

40. Distribute educational materials

Simple intervention: GPs mailed a pack containing: information letter for GPs, self-help booklet ('The Can Quit Book') to give to patients, plastic stand for GPs' office/waiting room

0

 + 

Facilitators:

Intervention characteristics: complexity (the intervention was simple and acceptable: survey found that 95% of primary care physicians could recall receiving copies of The Can Quit Book and most physicians reported giving them to patients)

Outer setting: external policies and incentives (GPs may have been affected by smoking cessation articles in medical journals and medical magazines, the RACGP’s Guidelines for Preventive Activities in General Practice, societal changes of embracing anti-smoking advice)

Barriers:

Outer setting: cosmopolitanism (lack of appropriate/easy referral system to effective cessation programs or products)

Serious

  Mullins, 2009 [51]

Delaware, USA

Domain 5

40. Distribute educational materials

42. Conduct educational meetings

AND

Domain 7

54. Prepare patients/consumers to be active participants

‘Ask and Act program’

Program contains:

(i) educational component for physicians (free patient materials for offices, continuing medical education programs for physicians and allied health professionals, and information on evidence-based interventions), and

(ii) free patient materials which engage patients (patient materials include pre-printed prescription pads with tips on how to quit, brochures, and laminated quitline referral cards. Metal lapel pins and wall posters act as visual cues to encourage patients to ask their family physician for help, and a guide to tobacco cessation group visits details how practices can organize and bill for counselling sessions)

 + 

 + 

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (physicians reported that they felt more comfortable with smoking cessation counselling and billing for this intervention, and that they were more likely to counsel their patients after hearing the presentation)

Serious

  Vasankari, 2011 [74]

Finland

42. Conduct educational meetings

Finnish ‘National Programme for Chronic Bronchitis and COPD 1998–2007’: training events organised in hospitals and primary health care centres, covering topics: COPD as a disease, diagnosis of COPD (spirometry), smoking cessation and treatment of COPD

 + 

Facilitators:

Outer setting: external policies and incentives (anti-smoking work and legislation on the national level, increased improvements in the national level of spirometry and knowledge of smoking habits of COPD patients)

Serious

Domain 7. Engage consumers

  Mullins, 2009 [51]

Delaware, USA

Domain 5

40. Distribute educational materials

42. Conduct educational meetings

AND

Domain 7

54. Prepare patients/consumers to be active participants

‘Ask and Act program’

Program contains:

(i) educational component for physicians (free patient materials for offices, continuing medical education programs for physicians and allied health professionals, and information on evidence-based interventions), and

(ii) free patient materials which engage patients (patient materials include pre-printed prescription pads with tips on how to quit, brochures, and laminated quitline referral cards. Metal lapel pins and wall posters act as visual cues to encourage patients to ask their family physician for help, and a guide to tobacco cessation group visits details how practices can organize and bill for counselling sessions)

 + 

 + 

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (physicians reported that they felt more comfortable with smoking cessation counselling and billing for this intervention, and that they were more likely to counsel their patients after hearing the presentation)

Serious

  Szatkowski, 2011 [33]

England

54. Prepare patients/consumers to be active participants

Introduction of smoke-free legislation

 + / 0

Barriers:

Outer setting: external policies and incentives (contextual factors and social norms continue to influence smoking behaviour: the provision of outdoor facilities for smoking, spending time with smoking friends)

Implementation process: executing (cessation support could have been advertised in the months after the smoke-free legislation was enacted)

Moderate

  Langley, 2012 [46]

England (and Wales)

56. Use mass media

Anti-tobacco mass media advertising, and pharmaceutical company-funded smoking cessation medication advertising

0

Barriers:

Implementation process: executing (effect of mass media campaign seems to be restricted to the month of the campaign, suggesting that campaigns need to be sustained over time; the messages of the mass media campaigns could be improved: greater focus on encouraging supported quit attempts, encouraging smokers to seek advice and medication from their GP)

Moderate

Domain 8. Utilize financial strategies

  Alageel, 2019 [31]

England

57. Fund and contract for the clinical innovation

NHS Health Check program (primary prevention of cardiovascular disease and related disorders)

 + 

 + 

 + 

Barriers:

Characteristics of individuals: knowledge and beliefs about the intervention (lower uptake of health checks among patients at greatest risk of cardiovascular disease)

Characteristics of individuals: knowledge and beliefs about the intervention (physicians have doubts about the effectiveness of the EBP, physicians lack guidance on how to implement risk management interventions which follow after risk factor detection)

Inner setting: structural characteristics (delivery of EBP is restricted by lack of time and follow-up in primary care)

Low

  Bennett, 2008 [65]

Ireland

57. Fund and contract for the clinical innovation

Heartwatch (secondary prevention of cardiovascular disease)

 + 

Barriers:

Outer setting: cosmopolitanism (further improvements may be achieved through improved linkages to community-based programmes and support)

Outer setting: patient needs and resources (further improvements may be achieved through attention to improving body weight, exercise levels and glucose metabolism)

Moderate

  Fitzpatrick, 2011 [66]

Ireland

57. Fund and contract for the clinical innovation

Heartwatch (secondary prevention of cardiovascular disease)

 + 

Facilitators:

Inner setting: implementation climate: (ii) compatibility (the effect of the intervention is likely to be additive, to the effect from secondary prevention interventions that already exist in primary care)

Barriers:

Inner setting: structural characteristics (delivery of EBP is restricted by lack of time and follow-up in primary care)

Serious

  Forster, 2016 [48]

England

57. Fund and contract for the clinical innovation

NHS Health Check program (primary prevention of cardiovascular disease and related disorders)

 + 

Barriers:

Characteristics of individuals: knowledge and beliefs about the intervention (lower uptake of health checks among patients who are smokers)

Low

  Frijling, 2003 [69]

Netherlands

57. Fund and contract for the clinical innovation

Cardiovascular disease (secondary) prevention program

 + 

Barriers:

Inner setting: readiness for implementation: (ii) available resources (GPs reported time constraints and insufficient financial recompense as a barrier to change, extra resources and personnel will be needed, GPs' current workload needs to be reduced)

Outer setting: patient needs and resources (multi-faceted interventions are more effective)

Serious

  Pajak, 2010 [73]

Poland

57. Fund and contract for the clinical innovation

Health Check Program of cardiovascular disease prevention

 + 

0

0

0

Barriers:

Inner setting: readiness for implementation: (iii) access to knowledge and information (the intervention should be enriched with well-designed structured intervention)

Characteristics of individuals: knowledge and beliefs about the intervention (less than 50% of family physicians felt competent to deliver smoking cessation interventions, primary care physicians have been shown to inadequate knowledge and to be not fully aware as to the efficacy of intervention on risk factors)

Inner setting: structural characteristics (primary care physicians have been shown to have time limitations)

Facilitators:

Inner setting: implementation climate: (iii) relative priority (over 90% of family physicians felt that health promotion should be a part of their daily work)

Inner setting: readiness for implementation: (ii) available resources (over 90% of family physicians had educational materials in their waiting rooms)

Moderate

  Bailey, 2016 [54]

Oregon, USA

59. Place innovation on fee for service lists/formularies

Increasing access to health insurance coverage which included smoking cessation treatment

 + 

 + 

Facilitators:

Inner setting: structural characteristics (increased access to consultations and follow-up consultations in primary care, increased access to cessation medications)

Outer setting: cosmopolitanism (increased access to smoking cessation counselling or referral for such services)

Moderate

  Bailey, 2020 [60]

United States (multi-state)

59. Place innovation on fee for service lists/formularies

Increasing access to health insurance coverage which included smoking cessation treatment

 + 

 + 

Facilitators:

Inner setting: structural characteristics (increased access to consultations in primary care, increased access to cessation medications)

Outer setting: cosmopolitanism (increased access to smoking cessation counselling or referral for such services)

Moderate

  Langley, 2011 [37]

England

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Introduction of a new cessation medication (varenicline) onto a country’s prescription scheme, December 2006

(ii) Introduction of NICE guideline for varenicline, July 2007

(i) + / 0

(ii) + / 0

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (measures to increase physicians' confidence in the effectiveness and safety of the medication)

Characteristics of individuals: knowledge and beliefs about the intervention (raising awareness of varenicline amongst smokers)

Moderate

  Li, 2018 [61]

United States (multi-state)

59. Place innovation on fee for service lists/formularies

Low-dose computed tomography for lung cancer screening (LDCT-LCS) became a Medicare-covered preventive service

 + 

Barriers:

Inner setting: readiness for implementation: (ii) available resources (lack of available staff time and financial factors)

Intervention characteristics: complexity (information in new guidelines was complex)

Serious

  Marino, 2016 [62]

Oregon, USA

59. Place innovation on fee for service lists/formularies

Increasing access to health insurance coverage which included smoking cessation treatment

 + 

Facilitators:

Inner setting: structural characteristics (increased access to primary care office visits)

Low

  Miraldo, 2018 [57]

Massachusetts, USA

59. Place innovation on fee for service lists/formularies

Increasing access to health insurance coverage which included smoking cessation treatment

0

Barriers:

Inner setting: structural characteristics (require an extensive amount of physician time)

Inner setting: implementation climate: (iii) relative priority (some physicians are not inclined to working with behavioural interventions and perceive risk reduction as something beyond their direct responsibility)

Characteristics of individuals: knowledge and beliefs about the intervention (differences across race/ethnic groups also suggest the need to tailor health interventions for multiple races, ethnicities and cultures)

Facilitators:

Outer setting: external policies and incentives (methods for encouraging healthy behaviour, coordinating care of chronic diseases)

Implementation process: reflecting and evaluating (multifaceted approaches to implementation, with a combination of activities such as audit and feedback and active education)

Moderate

  Parnes, 2002 [58]

Colorado, USA

59. Place innovation on fee for service lists/formularies

Health insurance types: uninsured vs Medicaid insured vs private/health maintenance organization (HMO) insured

 + 

Barriers:

Inner setting: structural characteristics (lack of access to cessation resources/treatment)

Inner setting: structural characteristics (competing demands on physicians' time)

Characteristics of individuals: other personal attributes (studies have documented a lower quality of care for Medicaid and uninsured patients with chronic diseases)

Moderate

  Tilson, 2004 [63]

Ireland

59. Place innovation on fee for service lists/formularies

Introduction of a new cessation medication (NRT) onto a country’s prescription scheme

 + / 0

Barriers:

Inner setting: structural characteristics (organisational issues)

Inner setting: structural characteristics (drug reimbursement)

Inner setting: readiness for implementation: (iii) access to knowledge and information (education and training)

Serious

  Verbiest, 2013 [67]

Netherlands

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Increasing access to health insurance coverage which included smoking cessation treatment

(ii) Introduction of the first Dutch guideline ‘Treatment of Tobacco Dependence’

(i) + 

(ii) 0

(i) + 

(ii) 0

Facilitators:

Inner setting: structural characteristics (increased access to cessation medications, health insurance coverage for smoking cessation treatment prompts GPs to prescribe evidence-based pharmaceuticals for smoking cessation)

Moderate

  Williams, 2004 [64]

Ireland

59. Place innovation on fee for service lists/formularies

Introduction of a new cessation medication (NRT) onto a country’s prescription scheme

 + / 0

N/A

Serious

  Bailey, 2017 [50]

Oregon, USA

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

67. Change record systems

‘Meaningful use’ (MU) criteria

(i) Change record systems: 2012: addition of 'readiness to quit' and 'counselling given' fields to the vital sign section of the medical record

(ii) 2014: Full implementation of policy, including incentive payments

 + 

 + 

 + 

 + 

Facilitators:

Inner setting: structural characteristics (inclusion of smoking status as a ‘vital sign’ increases the rate of identifying smokers)

Moderate

  Coleman, 2007 [32]

UK

60. Alter incentive/allowance structures

QOF 2004. Financially incentivised target for general practitioners:

to record their patients’ smoking status (‘ever’); and

to record smoking status every 15 months for patients who have coronary heart disease, diabetes mellitus, COPD, transient ischaemic attack or stroke, asthma, or hypertension, and every 15 months offer cessation advice or referral to a cessation service for these co-morbid patients who smoke

 + 

 + 

0

Facilitators:

Inner setting: structural characteristics (availability of cessation services to refer patients to, availability of nicotine treatment to prescribe)

Barriers:

Implementation process: executing (no targets were set for prescribing nicotine addiction treatments; the rates of NRT prescriptions did not increase)

Serious

  Dhalwani, 2013 [38]

UK

60. Alter incentive/allowance structures

QOF 2004

 + 

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (GPs' awareness of the impending introduction of the 2004 GP contract)

Serious

  Farley, 2017 [40]

UK

60. Alter incentive/allowance structures

QOF 2004

 + 

 + 

 + 

0

Barriers:

Inner setting: culture (cancer patients would benefit if general practitioners became more actively involved in supporting smoking cessation)

Facilitators:

Outer setting: external policy and incentives (QOF incentive not targeting cancer patients resulted in the increase of smoking targets for cancer patients too)

Low

  Fichera, 2016 [45]

England

60. Alter incentive/allowance structures

QOF 2004

0

0

Facilitators:

Inner setting: structural characteristics (improvements in care induced by the QOF for individuals with the targeted health conditions might include better monitoring of the condition, increased contacts with the doctor, healthcare, and lifestyle advice)

Moderate

  Fortmann, 2020 [56]

United States (multi-state)

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

71. Change accreditation or membership requirements

(i) Financial incentives via 'meaningful use' (MU) criteria

(ii) Accreditation requirement change: "in 2011, the Health Resources and Services Administration (HRSA)… updated its standards for documenting smoking and cessation counselling; these standards apply to all community health centres (CHCs) certified as Federally Qualified Community Health Centres and meeting all reporting requirements is a condition of funding”

 + 

Barriers:

Characteristics of individuals: other personal attributes (smoking status documentation was lower for younger patients, men, non-white subgroups, and patients with opioid use disorders)

Facilitators:

Characteristics of individuals: other personal attributes (most comorbidities were associated with higher odds of documented smoking status)

Moderate

  Hardy, 2014 [39]

UK

60. Alter incentive/allowance structures

QOF 2004

 + / 0

Facilitators:

Outer setting: external policy and incentives (QOF incentive not targeting pregnant patients resulted in the increase of smoking targets for these patients too)

Serious

  McGovern, 2008 [43]

Scotland

60. Alter incentive/allowance structures

QOF 2004

 + 

 + 

N/A

Serious

  Millett, 2007 [44]

UK

60. Alter incentive/allowance structures

QOF 2004

 + 

 + 

Facilitators:

Outer setting: external policies and incentives (reduced tobacco use in society, financial incentives are likely to be most effective in reducing the prevalence of smoking when combined with other quality improvement initiatives [e.g. active dissemination of clinical

guidelines on smoking cessation, ongoing training and support for front-line staff] within a comprehensive tobacco control strategy)

Inner setting: readiness for implementation: (ii) available resources (ongoing training and support for front-line staff)

Inner setting: readiness for implementation: (iii) access to knowledge and information (active dissemination of clinical guidelines on smoking cessation)

Serious

  Simpson, 2006 [49]

Scotland

60. Alter incentive/allowance structures

QOF 2004

 + 

 + 

Barriers:

Characteristics of individuals: knowledge and beliefs about the intervention (patients in deprived areas and males may be less willing to seek advice for their condition)

Characteristics of individuals: other personal attributes (average consultation length for deprived patients is ~ 1 to 2 min shorter than for affluent patients; this may have reduced the opportunity for GPs to record risk factors)

Facilitators:

Outer setting: external policies and incentives (other developments may have also contributed)

Serious

  Sutton, 2010 [47]

Scotland

60. Alter incentive/allowance structures

QOF 2004

 + 

N/A

Moderate

  Szatkowski, 2010 [29]

UK

60. Alter incentive/allowance structures

QOF 2004

 + 

N/A

Serious

  Szatkowski, 2011 [28]

England

60. Alter incentive/allowance structures

QOF 2004

 + / 0

Barriers:

Implementation process (discrepancy between practitioner-reported and patient-reported outcome measures is a problem)

Serious

  Szatkowski, 2016 [27]

England

60. Alter incentive/allowance structures

QOF 2012 amendment: encouraging GPs to offer referral to the NHS Stop Smoking Services and prescribe pharmacotherapy to all smokers, regardless of their smoking-related medical history

 + 

0

Barriers:

Implementation process: executing (the electronic codes that GPs were able to use to receive payment included the 'record of cessation advice' code that they had used before the policy change, when the 2012 policy was not intending to incentivise this action)

Moderate

  Taggar, 2012 [30]

UK

60. Alter incentive/allowance structures

(i) QOF 2004

(ii) QOF 2006, QOF 2008

2006 amendment: recording smoking status in patients without smoking-related morbidity was required periodically (every 27 months) rather than ‘ever’

2008 amendment: chronic kidney disease (CKD) and mental illness (schizophrenia, bipolar affective disorder and other psychoses) were added to the list of smoking-related conditions which required recording of smoking status and cessation advice every 15 months

(i): + 

(ii): 0

(i): + 

(ii): 0

Facilitators:

Implementation process: executing (specific wording within QOF targets is influential on clinical behaviour)

Serious

  Tahrani, 2007 [42]

England

60. Alter incentive/allowance structures

QOF 2004

 + 

 + 

N/A

Serious

  Akman, 2017 [72]

Turkey

Domain 8

65. Use capitated payments

AND

Domain 9

66. Mandate change, 67. Change record systems, 71. Change accreditation or membership requirements

‘Health Transformation Program’

Capitated payments: “With the introduction of new structure, family doctors are paid on a capitation basis with incentives for selected preventive services”

Mandate change:” To establish a stronger primary care system, in 2003 the Turkish government introduced the ‘Health Transformation Program’.”

Change record systems: “Facilities for the family health centres were improved compared to former health centres including computerization enabling electronic record keeping.”

Change accreditation or membership requirements: “Those primary care doctors who were formerly called ‘general practitioners’ were re-designated as ‘family doctors’ after completing a 10-day orientation course.”

0

Facilitators:

Outer setting: external policy and incentives (other contributing factors, health agenda has shifted from communicable and vaccine preventable diseases to non-communicable diseases)

Serious

  Donner-Banzhoff, 1996 [75]

Germany vs UK

65. Use capitated payments

Fee-For-Service (FFS) based systems (Germany) vs Capitation (UK)

0

0

Barriers:

Inner setting: culture (physicians show a lack of enthusiasm for encouraging smoking cessation because they are aware of the barriers that prevent their smoking patients from complying with their advice and the work does not conform with the traditional medical curative model)

Serious

Domain 9. Change infrastructure

  Akman, 2017 [72]

Turkey

Domain 8

65. Use capitated payments

AND

Domain 9

66. Mandate change, 67. Change record systems, 71. Change accreditation or membership requirements

‘Health Transformation Program’

Capitated payments: “With the introduction of new structure, family doctors are paid on a capitation basis with incentives for selected preventive services”

Mandate change:” To establish a stronger primary care system, in 2003 the Turkish government introduced the ‘Health Transformation Program’.”

Change record systems: “Facilities for the family health centres were improved compared to former health centres including computerization enabling electronic record keeping.”

Change accreditation or membership requirements: “Those primary care doctors who were formerly called ‘general practitioners’ were re-designated as ‘family doctors’ after completing a 10-day orientation course.”

0

Facilitators:

Outer setting: external policy and incentives (other contributing factors, health agenda has shifted from communicable and vaccine preventable diseases to non-communicable diseases)

Serious

  Szatkowski, 2021 [36]

England

66. Mandate change

Change to the public health commissioning infrastructure

-

Barriers:

Outer setting: external policies and incentives (where there is no local Stop Smoking Service to which general practitioners can refer pregnant women there is a reduced stimulus for discussion of smoking cessation and less direct prescribing of NRT)

Serious

  Bailey, 2017 [50]

Oregon, USA

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

67. Change record systems

‘Meaningful use’ (MU) criteria

(i) Change record systems: 2012: addition of 'readiness to quit' and 'counselling given' fields to the vital sign section of the medical record

(ii) 2014: Full implementation of policy, including incentive payments

 + 

 + 

 + 

 + 

Facilitators:

Inner setting: structural characteristics (inclusion of smoking status as a ‘vital sign’ increases the rate of identifying smokers)

Moderate

  Dhalwani, 2014 [41]

UK

69. Create or change credentialing and/or licensure standards

Clinical guideline change; broadening of indications for NRT for pregnant women

0

Facilitators:

Characteristics of individuals: other personal attributes (females with asthma or mental illnesses and those from more socioeconomically-deprived areas were more likely to receive prescriptions during pregnancy)

Serious

  Langley, 2011 [37]

England

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Introduction of a new cessation medication (varenicline) onto a country’s prescription scheme, December 2006

(ii) Introduction of NICE guideline for varenicline, July 2007

(i) + / 0

(ii) + / 0

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (measures to increase physicians' confidence in the effectiveness and safety of the medication)

Characteristics of individuals: knowledge and beliefs about the intervention (raising awareness of varenicline amongst smokers)

Moderate

  Langley, 2011 [34]

England

69. Create or change credentialing and/or licensure standards

Clinical guideline change; broadening of indications for NRT for adolescents

0

Barriers:

Outer setting: patient needs and resources (teenagers make fewer visits to their GP than adults and may be less likely than adults to ask for NRT, therefore general practice may not be an effective setting for the distribution of NRT to people within this age group)

Characteristics of individuals: knowledge and beliefs about the intervention (some young people would find using NRT embarrassing, unpleasant or expensive)

Characteristics of individuals: knowledge and beliefs about the intervention (concerns among healthcare professionals as to the safety of NRT for teenagers)

Inner setting: readiness for implementation: (iii) access to knowledge and information (lack of awareness of the licensing change among GPs)

Moderate

  Langley, 2012 [35]

England

69. Create or change credentialing and/or licensure standards

Clinical guideline change; broadening of indications for NRT for patients with cardiovascular disease

0

Barriers:

Outer setting: external policies and incentives (factors other than the licensing change have led to a widespread decrease in prescribing for NRT)

Moderate

  Li, 2020 [55]

United States (multi-state)

69. Create or change credentialing and/or licensure standards

US Preventive Services Task Force (USPSTF) 2013 guideline recommendation to provide low-dose computed tomography for lung cancer screening (LDCT-LCS)

 + 

 + 

 + 

Facilitators:

Outer setting: external policies and incentives (rereleased USPSTF recommendation in 2015 for clinicians to offer cessation support to smokers)

Serious

  Thorndike, 2007 [53]

United States (multi-state)

69. Create or change credentialing and/or licensure standards

Release and update of the US Public Health Service evidence-based national guidelines for the treatment of tobacco use

0

0

Barriers:

Inner setting: structural characteristics (lack of time to provide adequate preventive counselling, lack of insurance coverage for smoking cessation pharmacotherapies)

Characteristics of individuals: other personal attributes (competing demands of other medical problems during a visit)

Facilitators:

Outer setting: cosmopolitanism (embedding physicians in a broader system that integrates smoking cessation treatment more easily into practice [facilitating referral] and cessation support outside the office)

Inner setting: implementation climate: (iii) relative priority (most physicians regard addressing smoking as important)

Characteristics of individuals: knowledge and beliefs about the intervention (most physicians report feeling prepared to counsel about smoking)

Moderate

  Verbiest, 2013 [67]

Netherlands

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Increasing access to health insurance coverage which included smoking cessation treatment

(ii) Introduction of the first Dutch guideline ‘Treatment of Tobacco Dependence’

(i) + 

(ii) 0

(i) + 

(ii) 0

Facilitators:

Inner setting: structural characteristics (increased access to cessation medications, health insurance coverage for smoking cessation treatment prompts GPs to prescribe evidence-based pharmaceuticals for smoking cessation)

Moderate

  Fortmann, 2020 [56]

United States (multi-state)

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

71. Change accreditation or membership requirements

(i) Financial incentives via 'meaningful use' (MU) criteria

(ii) Accreditation requirement change: "in 2011, the Health Resources and Services Administration (HRSA)… updated its standards for documenting smoking and cessation counselling; these standards apply to all community health centres (CHCs) certified as Federally Qualified Community Health Centres and meeting all reporting requirements is a condition of funding”

 + 

Barriers:

Characteristics of individuals: other personal attributes (smoking status documentation was lower for younger patients, men, non-white subgroups, and patients with opioid use disorders)

Facilitators:

Characteristics of individuals: other personal attributes (most comorbidities were associated with higher odds of documented smoking status)

Moderate

  Peterson, 2016 [52]

United States (multi-state)

71. Change accreditation or membership requirements

Accreditation program for primary care physicians

 + 

Barriers:

Inner setting: implementation climate: (ii) compatibility (QI is difficult to sustain if it is not integrated into the existing culture and systems of care)

Serious

  Shi, 2017 [59]

United States (multi-state)

71. Change accreditation or membership requirements

Changing standards for primary care practices—'Patient-centered medical home' (PCMH) recognition status

 + 

 + 

 + 

N/A

Moderate

  Van Doorn-Klomberg, 2014 [68]

Netherlands

71. Change accreditation or membership requirements

Changing standards for primary care practices

 + / 0

 + / 0

0

Facilitators:

Implementation process: reflecting and evaluating (audit and feedback as a central mechanism)

Outer setting: external policies and incentives (other developments in the primary care field)

Intervention characteristics: complexity (adaptations to the program were made to reduce the burden of work)

Intervention characteristics: adaptability (health professionals can take ownership of the improvement plans that are tailored to the individual practices)

Moderate

Multiple domains^a

  Akman, 2017 [72]

Turkey

Domain 8

65. Use capitated payments

AND

Domain 9

66. Mandate change, 67. Change record systems, 71. Change accreditation or membership requirements

‘Health Transformation Program’

Capitated payments: “With the introduction of new structure, family doctors are paid on a capitation basis with incentives for selected preventive services”

Mandate change:” To establish a stronger primary care system, in 2003 the Turkish government introduced the ‘Health Transformation Program’.”

Change record systems: “Facilities for the family health centres were improved compared to former health centres including computerization enabling electronic record keeping.”

Change accreditation or membership requirements: “Those primary care doctors who were formerly called ‘general practitioners’ were re-designated as ‘family doctors’ after completing a 10-day orientation course.”

0

Facilitators:

Outer setting: external policy and incentives (other contributing factors, health agenda has shifted from communicable and vaccine preventable diseases to non-communicable diseases)

Serious

  Bailey, 2017 [50]

Oregon, USA

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

67. Change record systems

‘Meaningful use’ (MU) criteria

(i) Change record systems: 2012: addition of 'readiness to quit' and 'counselling given' fields to the vital sign section of the medical record

(ii) 2014: Full implementation of policy, including incentive payments

 + 

 + 

 + 

 + 

Facilitators:

Inner setting: structural characteristics (inclusion of smoking status as a ‘vital sign’ increases the rate of identifying smokers)

Moderate

  Fortmann, 2020 [56]

United States (multi-state)

Domain 8

60. Alter incentive/allowance structures

AND

Domain 9

71. Change accreditation or membership requirements

(i) Financial incentives via 'meaningful use' (MU) criteria

(ii) Accreditation requirement change: "in 2011, the Health Resources and Services Administration (HRSA)… updated its standards for documenting smoking and cessation counselling; these standards apply to all community health centres (CHCs) certified as Federally Qualified Community Health Centres and meeting all reporting requirements is a condition of funding”

 + 

Barriers:

Characteristics of individuals: other personal attributes (smoking status documentation was lower for younger patients, men, non-white subgroups, and patients with opioid use disorders)

Facilitators:

Characteristics of individuals: other personal attributes (most comorbidities were associated with higher odds of documented smoking status)

Moderate

  Langley, 2011 [37]

England

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Introduction of a new cessation medication (varenicline) onto a country’s prescription scheme, December 2006

(ii) Introduction of NICE guideline for varenicline, July 2007

(i) + / 0

(ii) + / 0

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (measures to increase physicians' confidence in the effectiveness and safety of the medication)

Characteristics of individuals: knowledge and beliefs about the intervention (raising awareness of varenicline amongst smokers)

Moderate

  Mullins, 2009 [51]

Delaware, USA

Domain 5

40. Distribute educational materials

42. Conduct educational meetings

AND

Domain 7

54. Prepare patients/consumers to be active participants

‘Ask and Act program’

Program contains:

(i) educational component for physicians (free patient materials for offices, continuing medical education programs for physicians and allied health professionals, and information on evidence-based interventions), and

(ii) free patient materials which engage patients (patient materials include pre-printed prescription pads with tips on how to quit, brochures, and laminated quitline referral cards. Metal lapel pins and wall posters act as visual cues to encourage patients to ask their family physician for help, and a guide to tobacco cessation group visits details how practices can organize and bill for counselling sessions)

 + 

 + 

Facilitators:

Inner setting: readiness for implementation: (iii) access to knowledge and information (physicians reported that they felt more comfortable with smoking cessation counselling and billing for this intervention, and that they were more likely to counsel their patients after hearing the presentation)

Serious

  Verbiest, 2013 [67]

Netherlands

Domain 8

59. Place innovation on fee for service lists/formularies

AND

Domain 9

69. Create or change credentialing and/or licensure standards

(i) Increasing access to health insurance coverage which included smoking cessation treatment

(ii) Introduction of the first Dutch guideline ‘Treatment of Tobacco Dependence’

(i) + 

(ii) 0

(i) + 

(ii) 0

Facilitators:

Inner setting: structural characteristics (increased access to cessation medications, health insurance coverage for smoking cessation treatment prompts GPs to prescribe evidence-based pharmaceuticals for smoking cessation)

Moderate