Table 1 Themes and sub-themes

Reimbursement Mechanism

The organization’s ability to implement the program will be based on whether they can receive reimbursement for MCR-Q

“It’s difficult because [we’re an] FQHC so um you know HRSA really decides what we do with our money.”

Organizational issues

Multi-disciplinary provider teams

The organization has multi-disciplinary teams (FQHC & Mental Health and Addiction Services), which is conducive to a smoking cessation program which requires a combination of medication and therapy

“Okay. Well we already have a lot of integration between the two sides. You know they were behavioral health for a long time and then they added primary care later. Um, so probably things that we have going first would be a good place to do it, cause we have like a whole integrated team that we have, approach with our patients.”

Aligning the human resource incentive program with MCR-Q

The organization utilizes productivity hours to measure staff productivity throughout with the exception of the primary care clinic and the program would need to align with this incentive structure

“I think XXXXX [Organization name] would really have to say hey this is what we’re gonna do for you if you do this. We’re gonna give you this much productivity for it. A lot of it depends on the productivity that’s gonna come out of this for the people.”

Provider behaviors

Lack of time

Team members expressed a lack of time or resources to making smoking cessation a priority

“I think you know, um, the challenge would be the case workers saying, this is one more thing I have to do. That would be a big one.”

Buy In/attitudes of providers and/or team members

Various team members have different levels of willingness to incorporate the program, and varying attitudes toward adopting this new program

“Yeah. But with the therapists you know I think most enjoy learning and trying out new things so.”

Provider prescribing behaviors

Getting providers who prescribe to change behaviors to incorporate potential side effects/interactions with smoking cessation drugs

“Um but help them understand that when they’re prescribing if they have a client in the smoking cessation program under Bubenorphine to please be willing to adjust the psychiatric meds as best able to support the program.”

Client concerns

Motivation to quit smoking

Getting clients to be motivated to have an intention to quit

“So, I think it’s—it’ll be difficult to try to get them to understand that they really need, you know, to stop smoking.”

Competing client social needs and priorities

Due to complex social needs (housing, transportation) of the clients, smoking cessation may not be feasible or the most appropriate need to address during clinic interactions

“I’ve always said it’s hard to stop drinking when you’re sleeping under a bridge it’s probably going to be hard to stop smoking too.”

“Just our population can be difficult and you know just being mindful of that. Uh they have a lot of barriers you know whatever their trying to do. Um you know a lot of our people are homeless who come here.”