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Bhatt G, Goel S, Grover S, Medhi B, Jaswal N, Gill SS, Singh G. Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State. PLoS One 2023; 18:e0284920. [PMID: 37141319 PMCID: PMC10159160 DOI: 10.1371/journal.pone.0284920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation. METHODS A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes. RESULTS The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives). CONCLUSION The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Jaswal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Singh Gill
- Department of Health & Family Welfare, Government of Punjab, National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke, Chandigarh, India
| | - Gurmandeep Singh
- Department of Health & Family Welfare, Government of Punjab, National Health Mission, Chandigarh, India
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Lucan SC, Ratz DL. Factors Associated with Smoking Cessation Counseling at Clinical Encounters: The Behavioral Risk Factor Surveillance System (BRFSS) 2000. Am J Health Promot 2018. [DOI: 10.1177/089011710602100105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Characterize factors associated with smoking-cessation counseling in clinical encounters. Design Cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) 2000 data. Setting U.S. households. Subjects 10,582 smokers (aged ≥ 18 years) reporting one or more clinical encounters during the prior year. Measures Multivariate-adjusted odds ratios (OR) and 95 % confidence intervals (CI) for quit advice associated with respondent and encounter variables. Results Almost 55 % of respondents were advised to quit smoking. Young men were advised to quit least often. Increasing age (18–24, 25–39, 40–64, ≥65 years) was associated with increasing odds of receiving quit advice (OR = 1.33, CI 1.10–1.61) for men. Other positive associations with quit advice included patient education, BMI, diagnosis of asthma, and private health insurance. Patients seeing physicians had greater odds of being advised to quit smoking (OR = 3.29, CI 2.13–5.06) than those seeing dentists. There was a 4% to 23% chance of receiving quit advice at any given nondental clinical encounter; the odds of such counseling did not rise significantly with the number of visits. Conclusion Smoking cessation counseling may be provided preferentially on the basis of patient demographics, and often is not provided at all. In a given year, just over half of smoking patients are advised to quit, and such counseling is provided at less than a quarter of clinical encounters.
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Affiliation(s)
- Sean C. Lucan
- Family Practice Residency Program, Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - David L. Ratz
- Yale Prevention Research Center and Public Health at the Yale University School of Medicine
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Pollak KI, Nagy P, Bigger J, Bilheimer A, Lyna P, Gao X, Lancaster M, Watkins RC, Johnson F, Batish S, Skelton JA, Armstrong S. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. PATIENT EDUCATION AND COUNSELING 2016; 99:300-303. [PMID: 26320822 DOI: 10.1016/j.pec.2015.08.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. METHODS We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. RESULTS Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. CONCLUSION This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. PRACTICE IMPLICATIONS It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA; Department of Community and Family Medicine, Duke School of Medicine, Durham, USA.
| | - Paul Nagy
- Department of Psychiatry, Duke School of Medicine, Durham, USA
| | | | - Alicia Bilheimer
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Pauline Lyna
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Xiaomei Gao
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | | | | | - Fred Johnson
- Division of Community Health, Department of Community and Family Medicine, Duke School of Medicine, Durham, USA
| | | | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke School of Medicine, Durham, USA
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Oberoi SS, Sharma G, Nagpal A, Oberoi A. Tobacco cessation in India: how can oral health professionals contribute? Asian Pac J Cancer Prev 2014; 15:2383-91. [PMID: 24716989 DOI: 10.7314/apjcp.2014.15.5.2383] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Tobacco use is described as the single most preventable cause of morbidity and mortality globally, with the World Bank predicting over 450 million tobacco-related deaths in the next fifty years. In India, the proportion of all deaths that can be attributed to tobacco use is expected to rise from 1.4% in 1990 to 13.3% in 2020 of which smoking alone will cause about 930,000 adult deaths by 2010. Many studies have shown that counseling from a health professional is an effective method of helping patients quit the tobacco habit. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidies of pharmacotherapy, developing wide-reaching strategies such as quitlines, and cost- effective strategies, including group interventions. The WHO Framework Convention on Tobacco Control (FCTC) emphasizes the vital contribution of participation of health professional bodies, as well as training and healthcare institutions in tobacco control efforts. Dentists can play an important role in helping patients quit using tobacco. One of the key strategies to reduce tobacco-related morbidity and mortality is to encourage the involvement of health professionals in tobacco-use prevention and cessation counselling. The dental office is an ideal setting for tobacco cessation services since preventive treatment services, oral screening, and patient education have always been a large part of the dental practice.
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Affiliation(s)
- Sukhvinder Singh Oberoi
- Oral Medicine and Radiology, Sudha Rustagi College of Dental Sciences and Research, Haryana, India E-mail :
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Mohanty VR, Rajesh GR, Aruna DS. Role of dental institutions in tobacco cessation in India: current status and future prospects. Asian Pac J Cancer Prev 2013; 14:2673-80. [PMID: 23725194 DOI: 10.7314/apjcp.2013.14.4.2673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Tobacco abuse is a major preventable cause of premature death and disease, including various cancers. The Global Adult Tobacco Survey India (GATS) 2009-10 revealed that more than one-third of adults use tobacco in one form or the other. Nearly two in five smokers and smokeless tobacco users made attempts to quit the habit in the past 12 months. Tobacco dependence is a chronic condition characterized by susceptibility of relapse over years. It can be well handled by sustained professional support from health care providers mainly through behavioral counseling and pharmacotherapy. Dental professionals can play a pivotal role in diagnosing and effectively managing tobacco dependence. Dental Institutions have rapidly grown in last two decades across the country and so has the curriculum been adapted to improve student competencies to accommodate changing disease patterns and technological advances, but not in regard to tobacco cessation. Untapped dental manpower like undergraduates, dental hygienists and other paramedical staff need effective training to be more penetrative. The present review paper explores the potential role of dental training institutions and recommends various approaches to counter public health jeopardy of tobacco related diseases.
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Affiliation(s)
- Vikrant Ranjan Mohanty
- Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India.
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Awopeju O, Erhabor G, Awosusi B, Awopeju O, Adewole O, Irabor I. Smoking prevalence and attitudes regarding its control among health professional students in South-Western Nigeria. Ann Med Health Sci Res 2013; 3:355-60. [PMID: 24116313 PMCID: PMC3793439 DOI: 10.4103/2141-9248.117944] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Tobacco use is one of the leading preventable causes of morbidity and mortality globally; about 70% of smokers see physicians each year. Health care professionals have a very unique role in motivating people to quit smoking. Aim: The aims of this study were to document the smoking prevalence and attitudes regarding its control among these set of students who will be tomorrow's health care providers. Subjects and Methods: A cross-sectional survey was conducted in two medical schools in South-Western Nigeria with their accompanied nursing and pharmacy students. All students in the selected schools were eligible to participate and student's participation was voluntary. The Global Health Professional Students Survey core questionnaire was used to collect data on smoking prevalence and attitudes regarding its control. The data were summarized using percentages and confidence interval (CI) was calculated using standard error of mean. Pearson's Chi-square and fisher's exact were employed to test the significance. Results: Life-time prevalence of cigarette smoking was 17.9% (121/675) with (95% confidence interval [CI] 15-20.8). Only 5.04% (34/675) with (95% CI 3.7-7.1) of the respondents were currently smoking. Ever smokers were significantly less likely than non-smokers to indicate that tobacco sales to adolescents should be banned (P < 0.01). Fewer smokers than non-smokers agreed that there should be a complete ban on advertising of tobacco products (P < 0.001). 93.3% of them said that they were taught about danger of smoking but only 48.6% ever heard of using anti-depressant in tobacco cessation program. Conclusions: Smoking prevalence among health professional students in South-West Nigeria is relatively low; however, majority believed that health-care providers serve as role models for their patients and the public.
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Affiliation(s)
- Of Awopeju
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Chang JC, Alexander SC, Holland CL, Arnold RM, Landsittel D, Tulsky JA, Pollak KI. Smoking is bad for babies: obstetric care providers' use of best practice smoking cessation counseling techniques. Am J Health Promot 2013; 27:170-6. [PMID: 23286593 PMCID: PMC3733346 DOI: 10.4278/ajhp.110624-qual-265] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange). DESIGN Observational study using audio recordings of first obstetric visits. SETTING An urban academic hospital-based clinic. PARTICIPANTS Obstetric care providers and pregnant women attending their first obstetric visit. METHOD First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling. RESULTS Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking. CONCLUSION Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.
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Affiliation(s)
- Judy C. Chang
- Department of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine, Magee-Womens Research Institute, and Center for Research in Health Care, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213, Phone: 412-641-1441, Fax: 412-641-1133,
| | - Stewart C. Alexander
- Department of Medicine and Center for Palliative Care, Duke University School of Medicine; Center for Health Services Research in Primary Care, VA Medical Center, 2424 Erwin Rd. Suite 602, Durham, NC 27705, Phone: 919-668-7220, Fax: 919-668-1300,
| | - Cynthia L. Holland
- Magee-Womens Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket St., Pittsburgh PA 15213, Phone: 412-641-4597, Fax: 412-624-6241,
| | - Robert M. Arnold
- Professor of Medicine, Chief, Section of Palliative Care and Medical Ethics, Assistant Director, Institute to Enhance Palliative Care, Director, Institute for Doctor-Patient Communication, UPMC Montefiore Hospital, Suite 932W, 200 Lothrop St., Pittsburgh PA, 15213, Phone: 412-692-4810, Fax: 412-656-7431,
| | - Douglas Landsittel
- Center for Research on Health Care Data Center, Institute for Clinical Research Education, University of Pittsburgh, 200 Meyran Ave., Suite 300, Pittsburgh PA, 15213, Phone: 412-864-3019, Fax: 412-586-9672,
| | - James A. Tulsky
- Department of Medicine and Center for Palliative Care, Duke University School of Medicine; Center for Health Services Research in Primary Care, VA Medical Center; Cancer Prevention, Detection, and Control Research Program, Duke Comprehensive Cancer Center, 2424 Erwin Rd., Hock Plaza, Suite 1105, Durham, NC 27705, Phone: 919-668-7215, Fax: 919-668-1300,
| | - Kathryn I. Pollak
- Community and Family Medicine, Duke University Medical Center; Cancer Prevention, Detection, and Control Research Program, Duke Comprehensive Cancer Center, 2424 Erwin Rd. Suite 602, Durham, NC 27705, Phone: 919-681-4757, Fax: 919-681-4785,
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Gill JM, Mainous AG, Koopman RJ, Player MS, Everett CJ, Chen YX, Diamond JJ, Lieberman MI. Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDs: a randomized controlled trial. Ann Fam Med 2011; 9:22-30. [PMID: 21242557 PMCID: PMC3022041 DOI: 10.1370/afm.1172] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/26/2010] [Accepted: 06/23/2010] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Electronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS This randomized controlled trial was conducted in a national network of primary care offices using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, anti-platelet medications [including aspirin], or corticosteroids; or an age of 75 years or older). The offices were randomized to receive EHR-based guidelines and alerts for high-risk patients on NSAIDs, or usual care. The primary outcome was the proportion of patients who received guideline-concordant care during the 1-year study period (June 2007-June 2008), defined as having their traditional NSAID discontinued (including a switch to a lower-risk medication), having a gastroprotective medication coprescribed, or both. RESULTS Participants included 27 offices with 119 clinicians and 5,234 high-risk patients. Intervention patients were more likely than usual care patients to receive guideline-concordant care (25.4% vs 22.4%, adjusted odds ratio = 1.19; 95% confidence interval, 1.01-1.42). For individual high-risk groups, patients on low-dose aspirin were more likely to receive guideline-concordant care with the intervention vs usual care (25.0% vs 20.8%, adjusted odds ratio = 1.30; 95% confidence interval, 1.04-1.62), but there was no significant difference for patients in other high-risk groups. CONCLUSIONS This study showed only a small impact of EHR-based clinical decision support for high-risk patients on NSAIDs in primary care offices. These results add to the growing literature about the complexity of EHR-based clinical decision support for improving quality of care.
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Affiliation(s)
- James M Gill
- Delaware Valley Outcomes Research, Newark, DE, USA.
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Meshefedjian GA, Gervais A, Tremblay M, Villeneuve D, O'Loughlin J. Physician smoking status may influence cessation counseling practices. Canadian Journal of Public Health 2010. [PMID: 21033533 DOI: 10.1007/bf03405288] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smoking cessation counseling practices may differ between physicians who smoke and those who have quit or never smoked. METHOD Of 917 general practitioners (GP) in Montreal mailed self-report questionnaires in 2000 and 2004, 610 provided data on their smoking status and counseling practices. RESULTS Seven percent were current smokers, 32% were former smokers, and 61% were never-smokers. Current smokers were more interested than never- or former smokers in learning about counseling methods (64%, 56%, 45%, respectively; p = 0.018). In multivariable analyses, current smokers were less likely than never-smokers to ascertain the smoking status of their patients (OR 0.6, 95% CI 0.2-1.6); to provide advice on how to quit (OR 0.6, 0.3-1.3); and to provide complete cessation counseling coverage (OR 0.5, 0.2-1.1). Former smokers were more likely to provide adjunct support (OR 1.5, 1.0-2.4). CONCLUSION GP smoking status was associated with the content of their cessation interventions with patients who smoke. Taking physician smoking status into consideration in the design of cessation training programs may improve cessation counseling interventions.
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Affiliation(s)
- Garbis A Meshefedjian
- Agence de la santé et des services sociaux de Montréal, Direction de sante publique, Montréal, QC.
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Mitchell J, Brown JB, Smith C. Interprofessional education: a nurse practitioner impacts family medicine residents' smoking cessation counselling experiences. J Interprof Care 2010; 23:401-9. [PMID: 19242852 DOI: 10.1080/13561820802490941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This qualitative research paper describes a successful example of interprofessional education with family medicine residents (FMR) by a nurse practitioner (NP) colleague. The educational impact of the NP role in regard to smoking cessation counselling is revealed by the analysis of 16 semi-structured interviews using a phenomenological approach. The key themes depicted the NP as an educator and mentor, encourager and referral resource. Outcomes of improved knowledge, skills, and motivation towards providing smoking cessation counselling are described. This research provides some understanding of how professional students' learning and practice can be affected by a member of another profession through direct and indirect approaches. The experiences identified how interprofessional education and collaborative clinical practice can affect FMRs' attitudes, knowledge and behaviours. This learning can guide us in enhancing the quality of education provided to all health care professionals.
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Affiliation(s)
- Joan Mitchell
- Byron Family Medical Centre, London, Ontario, Canada.
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Chun J, Guydish JR, Delucchi K. Does the Presence of a Smoking Cessation Clinical Trial Affect Staff Practices Related to Smoking? JOURNAL OF DRUG ISSUES 2009; 39:1. [PMID: 20057920 PMCID: PMC2802349 DOI: 10.1177/002204260903900209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated whether organizational changes occurred when nicotine treatments were tested in specialty care clinics. Two intervention clinics (one drug treatment and one HIV-care) participated in clinical trials for nicotine treatment. Three clinics (two drug and one HIV-care) were control clinics. Staff in the intervention clinics (n=57) and in the control clinics (n=62) were surveyed at baseline and 18 months later. Staff surveys concerned nicotine-related knowledge, beliefs about treating smoking, self-efficacy in delivering such treatment, nicotine related practices, and barriers to providing nicotine treatment. Mean scale scores at 18 months were no different in clinics participating in the clinical trials from the control group for any of the five scales (knowledge, practices, barriers, efficacy, and beliefs). The presence of a smoking cessation clinical trial did not influence staff knowledge, attitudes, or practices related to smoking in these clinics. More specific organizational intervention may influence staff practices related to addressing smoking among clients in drug treatment and HIV-care clinics.
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Affiliation(s)
- Jongserl Chun
- Graduate School of Social Welfare at Ewha Woman's University, Seoul, South Korea
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Pollak KI, Krause KM, Yarnall KSH, Gradison M, Michener JL, Østbye T. Estimated time spent on preventive services by primary care physicians. BMC Health Serv Res 2008; 8:245. [PMID: 19046443 PMCID: PMC2630318 DOI: 10.1186/1472-6963-8-245] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 12/01/2008] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. METHODS We analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001-4); analyses were conducted 2007-8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. RESULTS Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling. CONCLUSION Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.
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Affiliation(s)
- Kathryn I Pollak
- Department of Community and Family Medicine, Duke University Medical Center
- Duke Comprehensive Cancer Center, Cancer Prevention, Detection and Control Research Program
| | - Katrina M Krause
- Department of Community and Family Medicine, Duke University Medical Center
| | | | - Margaret Gradison
- Department of Community and Family Medicine, Duke University Medical Center
| | - J Lloyd Michener
- Department of Community and Family Medicine, Duke University Medical Center
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center
- Duke NUS Graduate Medical School Singapore, 11 Hospital Drive, Level 4 Singapore 169610
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O'Loughlin J, Makni H, Tremblay M, Karp I. Gender differences among general practitioners in smoking cessation counseling practices. Prev Med 2007; 45:208-14. [PMID: 17631386 DOI: 10.1016/j.ypmed.2007.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender. METHODS Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000. RESULTS Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p<0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs. CONCLUSIONS Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.
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Affiliation(s)
- Jennifer O'Loughlin
- CR-CHUM and Department of Social and Preventive Medicine, University of Montreal, Montréal, Québec, Canada.
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Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers. J Gen Intern Med 2005; 20:386-91. [PMID: 15963158 PMCID: PMC1490125 DOI: 10.1111/j.1525-1497.2005.0024.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. DESIGN Cross-sectional national mail survey of residents (63% response rate). PARTICIPANTS Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers. MEASUREMENTS Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression. RESULTS Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents' perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents' perceived preparedness. CONCLUSIONS Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills.
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Gorin SS, Heck JE. Meta-Analysis of the Efficacy of Tobacco Counseling by Health Care Providers. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.2012.13.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Given the proportion of American adults who smoke, even if health professionals only have a small effect on quit rates, the public health impact of this change could potentially be enormous. Yet, health care providers may differ in their cessation efficacy. The purpose of this study was to evaluate recent rigorous trials of smoking cessation counseling among physicians, nurses, dentists, and teams of providers: (1) to compare providers on the efficacy of cessation and (2)to determine which intervention and study characteristics explain variations in intervention effects. Thirty-seven randomized clinical trials or quasi-experiments (with control groups) of health care provider–delivered smoking cessation interventions, out of over 200 articles that were published between 1990 and 2004 were collected through searches of Medline, CINAHL, PSYCINFO, and dissertation abstracts, as well as hand searches. The outcome modeled was the mean difference between intervention and control groups in the cessation rates using Hedges g. The univariate results revealed that receiving advice from any health care professional produced increases in quit rates. Multivariate analyses of intervention effects on cessation revealed that physicians were most effective, followed by multiprovider teams, dentists, and nurses. The findings suggest that contact with a health care professional will increase cessation; however, additional training in tobacco control for nurses is warranted. Longer-term studies of smoking cessation, particularly among dentists, are necessary.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- 1Department of Health and Behavior Studies,
- 2Herbert Irving Comprehensive Cancer Center, and
| | - Julia E. Heck
- 3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Pollak KI, Taiwo B, Lyna P, Baldwin M, Lipkus IM, Bepler G, McBride CM. Reported cessation advice given to African Americans by health care providers in a community health clinic. J Community Health 2002; 27:381-93. [PMID: 12458781 DOI: 10.1023/a:1020659400705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Physician smoking cessation advice has been shown to be effective in encouraging patients to attempt cessation. Few studies have examined factors associated with patient-reported physician advice in an inner city community health clinic. Smokers identified via chart review and provider referral met with a study "smoking specialist." Eligible participants self-identified as African American, smoked at least 1 cigarette per day in the prior 7 days, were 18 or older, had access to a telephone, and agreed to consider blood testing for genetic susceptibility to lung cancer. Of the 869 smokers identified, 487 were eligible and completed a brief in-person and a more extensive follow-up telephone survey within one week after their visit. Patient reports of smoking cessation advice by providers were regressed on patient demographic, smoking, health, and social support variables. Seventy percent of participants reported that they had been advised to quit smoking. Smokers who were older, did not smoke menthol cigarettes, were in poorer health, and who had a regular health care provider were most likely to report having received advice. Patients in this community health setting reported high rates of provider advice to quit smoking. Yet, even in this optimal condition, young healthy smokers did not report receiving advice, even when they were ready to quit smoking. Providers may need additional training and prompting to counsel young healthy smokers about the importance of cessation.
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Affiliation(s)
- Kathryn I Pollak
- Duke Comprehensive Cancer Center, Cancer Prevention, Detection and Control Research Program, Duke University Medical Center, Durham, NC 27710-2949, USA.
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