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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Gilbert H, Sutton S, Morris R, Petersen I, Wu Q, Parrott S, Galton S, Kale D, Magee MS, Gardner L, Nazareth I. Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the NHS Stop Smoking Services. Health Technol Assess 2018; 21:1-206. [PMID: 28121288 DOI: 10.3310/hta21030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The NHS Stop Smoking Services (SSSs) offer help to smokers who want to quit. However, the proportion of smokers attending the SSSs is low and current figures show a continuing downward trend. This research addressed the problem of how to motivate more smokers to accept help to quit. OBJECTIVES To assess the relative effectiveness, and cost-effectiveness, of an intervention consisting of proactive recruitment by a brief computer-tailored personal risk letter and an invitation to a 'Come and Try it' taster session to provide information about the SSSs, compared with a standard generic letter advertising the service, in terms of attendance at the SSSs of at least one session and validated 7-day point prevalent abstinence at the 6-month follow-up. DESIGN Randomised controlled trial of a complex intervention with follow-up 6 months after the date of randomisation. SETTING SSSs and general practices in England. PARTICIPANTS All smokers aged ≥ 16 years identified from medical records in participating practices who were motivated to quit and who had not attended the SSS in the previous 12 months. Participants were randomised in the ratio 3 : 2 (intervention to control) by a computer program. INTERVENTIONS Intervention - brief personalised and tailored letter sent from the general practitioner using information obtained from the screening questionnaire and from medical records, and an invitation to attend a taster session, run by the local SSS. Control - standard generic letter from the general practice advertising the local SSS and the therapies available, and asking the smoker to contact the service to make an appointment. MAIN OUTCOME MEASURES (1) Proportion of people attending the first session of a 6-week course over a period of 6 months from the receipt of the invitation letter, measured by records of attendance at the SSSs; (2) 7-day point prevalent abstinence at the 6-month follow-up, validated by salivary cotinine analysis; and (3) cost-effectiveness of the intervention. RESULTS Eighteen SSSs and 99 practices within the SSS areas participated; 4384 participants were randomised to the intervention (n = 2636) or control (n = 1748). One participant withdrew and 4383 were analysed. The proportion of people attending the first session of a SSS course was significantly higher in the intervention group than in the control group [17.4% vs. 9.0%; unadjusted odds ratio (OR) 2.12, 95% confidence interval (CI) 1.75 to 2.57; p < 0.001]. The validated 7-day point prevalent abstinence at the 6-month follow-up was significantly higher in the intervention group than in the control group (9.0% vs. 5.6%; unadjusted OR 1.68, 95% CI 1.32 to 2.15; p < 0.001), as was the validated 3-month prolonged abstinence and all other periods of abstinence measured by self-report. Using the National Institute for Health and Care Excellence decision-making threshold range of £20,000-30,000 per quality-adjusted life-year gained, the probability that the intervention was more cost-effective than the control was up to 27% at 6 months and > 86% over a lifetime horizon. LIMITATIONS Participating SSSs may not be representative of all SSSs in England. Recruitment was low, at 4%. CONCLUSIONS The Start2quit trial added to evidence that a proactive approach with an intensive intervention to deliver personalised risk information and offer a no-commitment introductory session can be successful in reaching more smokers and increasing the uptake of the SSS and quit rates. The intervention appears less likely to be cost-effective in the short term, but is highly likely to be cost-effective over a lifetime horizon. FUTURE WORK Further research could assess the separate effects of these components. TRIAL REGISTRATION Current Controlled Trials ISRCTN76561916. FUNDING DETAILS This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hazel Gilbert
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Simon Galton
- Smokefree Camden (Public Health), NHS Camden, London, UK
| | - Dimitra Kale
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Molly Sweeney Magee
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Leanne Gardner
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London, London, UK
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Simonavicius E, Robson D, McEwen A, Brose LS. Cessation support for smokers with mental health problems: a survey of resources and training needs. J Subst Abuse Treat 2017; 80:37-44. [PMID: 28755771 PMCID: PMC5555355 DOI: 10.1016/j.jsat.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 01/05/2023]
Abstract
AIMS Around thirty percent of smokers have a mental health problem. Smoking cessation has been associated with mental health benefits, but smoking prevalence remains high in populations with mental health problems. This study aimed to assess mental health related knowledge, practice, and training needs of practitioners supporting smoking cessation. METHODS UK stop smoking practitioners (n=717) recruited via a database of a national provider of smoking cessation training in June 2016 sufficiently completed an online survey about available resources, knowledge, confidence, and training needs related to smoking cessation and mental health. Responses were described and compared between practitioners with a mental health lead and those without such a lead in their service using chi-square statistics and t-tests. RESULTS A considerable proportion agreed (37%) or were undecided (28.9%) that smoking helped people with mental health problems feel better and agreed (17.2%) or were undecided (30.2%) that cessation would exacerbate mental health symptoms. Only 11.6% said their service had designated funding for smokers with mental health problems and 26.5% were or had a staff member who was a dedicated lead practitioner for mental health work. Practitioners from services that had a dedicated mental health lead were more confident in supporting smokers with different mental health problems and using different pharmacotherapies (all p<0.001) and were more likely to disagree that cessation was detrimental (p=0.001). A majority of practitioners were interested in training, particularly about smoking cessation effects on psychiatric medication (84.3% of n=632) and how to tailor stop smoking support to clients with mental health problems (82.4%). CONCLUSION Practitioners who support smoking cessation have limited knowledge about mental health and smoking but are willing to learn and improve. However, they are hindered by a lack of resources.
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Affiliation(s)
- Erikas Simonavicius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Debbie Robson
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, United Kingdom
| | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom
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Proportion of Time Spent Delivering Support Predicts Stop Smoking Advisor Quit Rate Independently of Training, Experience, and Education. J Smok Cessat 2017. [DOI: 10.1017/jsc.2016.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite a downwards trend in smoking prevalence, smoking remains the UK's biggest preventable cause of premature mortality. Specialist stop smoking support programmes provided by the NHS have helped to reduce smoking prevalence and whilst there has been a vast amount of research investigating the most effective behavioural and pharmacological support models, little is known about the impact of smoking cessation advisor's smoking status and clinical effectiveness on quit rates. This study aimed to identify factors that contribute to NHS stop smoking advisor performance using a quantitative cross-sectional design via an online survey that was completed by 159 participants in 24 London boroughs. Multiple regression analyses revealed that level of training, years practiced, level of advisor education, number of patients supported in a given year, and smoking status had no significant impact on NHS stop smoking advisor quit rate in this sample. However, the model revealed that proportion of time spent delivering smoking cessation support was significantly associated with quit rate. It is imperative that this finding is considered when recruiting, commissioning, and training new smoking cessation advisors or provider organisations.
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Faulkner K, Sutton S, Jamison J, Sloan M, Boase S, Naughton F. Are Nurses and Auxiliary Healthcare Workers Equally Effective in Delivering Smoking Cessation Support in Primary Care? Nicotine Tob Res 2015; 18:1054-60. [PMID: 26453668 PMCID: PMC4826488 DOI: 10.1093/ntr/ntv206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/29/2015] [Indexed: 11/23/2022]
Abstract
Introduction: Smoking cessation support is increasingly delivered in primary care by auxiliary healthcare workers in place of healthcare professionals. However, it is unknown whether this shift might affect the quality and impact of the support delivered. Methods: Data from the iQuit in Practice randomized control trial of cessation support in General Practice was used (N = 602). Analyses assessed whether cessation advisor type (nurse or healthcare assistant [HCA]) was associated with abstinence (primary outcome: self-reported 2-week point prevalence abstinence at 8 weeks follow-up), the advice delivered during the initial consultation, pharmacotherapies prescribed, patient satisfaction, initial consultation length, and the number and type of interim contacts. Results: There were no statistically significant differences in abstinence for support delivered by HCAs versus nurses at 8 weeks (HCAs 42.8%, nurses 42.6%; unadjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.73 to 1.40), or at 4 weeks or 6 months follow-up. There were no statistically significant differences in advice delivered, the types of pharmacotherapies prescribed or patient satisfaction. Compared with nurses, HCA consultations were longer on average (HCAs 23.6 minutes, nurses 20.8 minutes; P = .002) and they undertook more interim contacts (HCAs median 2, nurses median 1; P < .001), with contact more likely to be face-to-face than phone call (HCAs 91.2%, nurses 70.9%; OR = 4.23, 95% CI = 2.86 to 6.26). Conclusions: HCAs appear equally effective as nurses in supporting smoking cessation, although they do this with greater patient contact. Using auxiliary practitioners to deliver cessation support could free up nurse time and reduce costs. Implications: This study found that primary care patients receiving smoking cessation support from auxiliary healthcare workers were just as likely to be abstinent up to 6 months later as those patients seen by nurses. While the auxiliary healthcare workers achieved this with slightly increased patient contact time, the advice delivered, pharmacotherapies provided and patient satisfaction were similar to that of nurses. Expanding the auxiliary healthcare worker role to include smoking cessation support could increase role satisfaction and reduce the costs of cessation support delivery in primary care.
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Affiliation(s)
- Kathryn Faulkner
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - James Jamison
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Melanie Sloan
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Sue Boase
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
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Song F, Maskrey V, Blyth A, Brown TJ, Barton GR, Aveyard P, Notley C, Holland R, Bachmann MO, Sutton S, Brandon TH. Differences in Longer-Term Smoking Abstinence After Treatment by Specialist or Nonspecialist Advisors: Secondary Analysis of Data From a Relapse Prevention Trial. Nicotine Tob Res 2015; 18:1061-6. [PMID: 26152558 PMCID: PMC4826486 DOI: 10.1093/ntr/ntv148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/27/2015] [Indexed: 11/14/2022]
Abstract
Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term smoking cessation treatment from specialist and nonspecialist smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of self-help booklets for the prevention of smoking relapse. The trial included 1088 short-term quitters from specialist stop smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous smoking abstinence and the type of smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and smoking variables, the specialist service was significantly associated with a higher rate of longer-term smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop smoking from a specialist appear to be at lower risk of relapse than those receiving support from a nonspecialist advisor.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom;
| | - Vivienne Maskrey
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Garry R Barton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norwich Clinical Trial Unit, University of East Anglia, Norwich, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
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McElwaine KM, Freund M, Campbell EM, Knight J, Bowman JA, Wolfenden L, McElduff P, Bartlem KM, Gillham KE, Wiggers JH. Increasing preventive care by primary care nursing and allied health clinicians: a non-randomized controlled trial. Am J Prev Med 2014; 47:424-34. [PMID: 25240966 DOI: 10.1016/j.amepre.2014.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 05/13/2014] [Accepted: 06/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally. PURPOSE To assess the effectiveness of a practice change intervention in increasing primary care nursing and allied health clinician provision of preventive care for four health risks. DESIGN Two-group (intervention versus control), non-randomized controlled study assessing the effectiveness of the intervention in increasing clinician provision of preventive care. SETTING/PARTICIPANTS Randomly selected clients from 17 primary healthcare facilities participated in telephone surveys that assessed their receipt of preventive care prior to (September 2009-2010, n=876) and following intervention (October 2011-2012, n=1,113). INTERVENTION The intervention involved local leadership and consensus processes, electronic medical record system modification, educational meetings and outreach, provision of practice change resources and support, and performance monitoring and feedback. MAIN OUTCOME MEASURES The primary outcome was differential change in client-reported receipt of three elements of preventive care (assessment, brief advice, referral/follow-up) for each of four behavioral risks individually (smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, physical inactivity) and combined. Logistic regression assessed intervention effectiveness. RESULTS Analyses conducted in 2013 indicated significant improvements in preventive care delivery in the intervention compared to the control group from baseline to follow-up for assessment of fruit and vegetable consumption (+23.8% vs -1.5%); physical activity (+11.1% vs -0.3%); all four risks combined (+16.9% vs -1.0%) and for brief advice for inadequate fruit and vegetable consumption (+19.3% vs -2.0%); alcohol overconsumption (+14.5% vs -8.9%); and all four risks combined (+14.3% vs +2.2%). The intervention was ineffective in increasing the provision of the remaining forms of preventive care. CONCLUSIONS The intervention's impact on the provision of preventive care varied by both care element and risk type. Further intervention is required to increase the consistent provision of preventive care, particularly referral/follow-up.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Jenny Knight
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Patrick McElduff
- Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
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Brose LS, West R, McEwen A. How stable are stop smoking practitioner success rates over time? Transl Behav Med 2014; 4:220-5. [PMID: 24904706 PMCID: PMC4041933 DOI: 10.1007/s13142-014-0261-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Stop smoking practitioners appear to differ in effectiveness, but the stability of their success rates over time is unknown. The purpose of this study was to assess the degree of stability of success rates of stop smoking practitioners over several years of practice. Using routinely collected practice data, the success rates of 197 practitioners active between April 2009 and April 2012 in the English stop smoking services were correlated across years before and after adjusting for client and intervention characteristics. Changes in client and intervention characteristics were assessed. Success rates for individual practitioners correlated highly in successive years (r = 0.64 to 0.68, p < 0.001, ICC = 0.56) and moderately over non-successive years (r = 0.39 to 0.51, p < 0.001). There was no evidence for increasing effectiveness over time. Practitioners' effectiveness is moderately stable over time. Research is needed to establish what characterises the practice of the more successful practitioners.
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Affiliation(s)
- Leonie S. Brose
- />UK Centre for Tobacco and Alcohol Studies, Addictions, Institute of Psychiatry, King’s College London, London, UK
| | - Robert West
- />Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Andy McEwen
- />Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- />National Centre for Smoking Cessation and Training (NCSCT), London, UK
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McElwaine KM, Freund M, Campbell EM, Slattery C, Wye PM, Lecathelinais C, Bartlem KM, Gillham KE, Wiggers JH. Clinician assessment, advice and referral for multiple health risk behaviors: prevalence and predictors of delivery by primary health care nurses and allied health professionals. PATIENT EDUCATION AND COUNSELING 2014; 94:193-201. [PMID: 24284164 DOI: 10.1016/j.pec.2013.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Primary care clinicians have considerable potential to provide preventive care. This study describes their preventive care delivery. METHODS A survey of 384 community health nurses and allied health clinicians from in New South Wales, Australia was undertaken (2010-11) to examine the assessment of client risk, provision of brief advice and referral/follow-up regarding smoking inadequate fruit and vegetable consumption, alcohol misuse, and physical inactivity; the existence of preventive care support strategies; and the association between supports and preventive care provision. RESULTS Preventive care to 80% or more clients was least often provided for referral/follow-up (24.7-45.6% of clinicians for individual risks, and 24.2% for all risks) and most often for assessment (34.4-69.3% of clinicians for individual risks, and 24.4% for all risks). Approximately 75% reported having 9 or fewer of 17 supports. Provision of care was associated with: availability of a paper screening tool; training; GP referral letter; and number of supports. CONCLUSION The delivery of preventive care was limited, and varied according to type of care and risk. Supports were variably associated with elements of preventive care. PRACTICE IMPLICATIONS Further research is required to increase routine preventive care delivery and the availability of supports.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Carolyn Slattery
- Population Health, Hunter New England Local Health District, Newcastle, Australia.
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | | | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
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Lindson-Hawley N, Begh R, McDermott MS, McEwen A, Lycett D. The importance of practitioner smoking status: a survey of NHS Stop Smoking Service practitioners. PATIENT EDUCATION AND COUNSELING 2013; 93:139-145. [PMID: 23711634 DOI: 10.1016/j.pec.2013.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/25/2013] [Accepted: 04/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the smoking status of stop smoking practitioners, the impact of this on their practice, and clients' quit rates. METHODS Smoking cessation practitioners in the UK NHS Stop Smoking Service were asked about their smoking status, client quit rates and practitioner-client interaction, using an online survey. Associations between responses were investigated using logistic regression. RESULTS 51% of the sample (N=484) were ex-smokers. Most practitioners had been questioned about their smoking status by clients, with more never than ex-smokers claiming that this reduced their confidence when advising. Never smokers more frequently reported that clients questioned their ability as a practitioner, but no significant difference in quit rates was reported between never and ex-smokers. CONCLUSION Although evidence suggests smokers believe many practitioners are never smokers, this survey found that this is not true. Research investigating how many smokers might not be seeking support to quit because of this could be beneficial. PRACTICE IMPLICATIONS Raising awareness of the similarity of quit rates achieved by never and former smoker practitioners, and the experience practitioners draw upon when offering advice, might encourage greater use of the NHS SSS. It could also be beneficial to improve training in never smokers to address confidence issues.
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McDermott MS, Beard E, Brose LS, West R, McEwen A. Factors Associated With Differences in Quit Rates Between “Specialist” and “Community” Stop-Smoking Practitioners in the English Stop-Smoking Services. Nicotine Tob Res 2012; 15:1239-47. [DOI: 10.1093/ntr/nts262] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Brose LS, McEwen A, West R. Does it matter who you see to help you stop smoking? Short-term quit rates across specialist stop smoking practitioners in England. Addiction 2012; 107:2029-36. [PMID: 22571648 DOI: 10.1111/j.1360-0443.2012.03935.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/18/2011] [Accepted: 05/03/2012] [Indexed: 11/28/2022]
Abstract
AIMS A network of Stop Smoking Services has been set up within the National Health Service (NHS) in England. The services deliver a combination of behavioural support and medication. It is important to establish the degree of variability in quit rates attributable to differences between individual practitioners, to gauge the scope for improvement by training and professional support. The aim of the present analysis was to examine how far short-term quit rates depend on the practitioner delivering the intervention after adjusting for potential confounding variables. DESIGN Observational study using routinely collected data. SETTING Thirty-one NHS Stop Smoking Services in England. PARTICIPANTS Data from 46,237 one-to-one treatment episodes (supported quit attempts) delivered by specialist practitioners. MEASUREMENTS Three-level logistic regression models were fitted for carbon monoxide (CO)-validated short-term (4-week) quit rates. Models adjusted for age, gender, exemption from prescription charges, medication and intervention setting for each treatment episode, number of clients for each practitioner and economic deprivation at the level of the Stop Smoking Service. Secondary analyses included (i) the heaviness-of-smoking index (HSI) as predictor and (ii) 4-week quit rates whether or not confirmed by CO. FINDINGS Differences between individual specialist practitioners explained 7.6% of the variance in CO-verified quit rates after adjusting for client demographics, intervention characteristics and practitioner and service variables (P < 0.001). HSI had little impact on this figure; in quits not necessarily validated by CO, practitioners explained less variance. CONCLUSIONS Individual stop smoking practitioners appear to differ to a significant degree in effectiveness. It is important to examine what underlies these differences in order to improve selection, training and professional development.
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Affiliation(s)
- Leonie S Brose
- National Centre for Smoking Cessation and Training, University College London, London, UK.
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Duaso M, Duncan D. Health impact of smoking and smoking cessation strategies: current evidence. Br J Community Nurs 2012; 17:356-63. [PMID: 22875209 DOI: 10.12968/bjcn.2012.17.8.356] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Smoking continues to be the main preventable cause of death in the UK. Tobacco consumption causes a wide range of diseases and other adverse effects, including multiple types of cancer, chronic obstructive pulmonary disease, cardiovascular disease, pregnancy complications, cataracts and osteoporosis. The Government's vision to 'make every contact count' emphasises community nurses' responsibility and key potential to promote healthier living and behaviour. This article reviews the latest evidence on supporting smokers in practice and argues that nurses working in the community are ideally placed to record smoking status, give advice, encouragement and support, refer people to local smoking cessation services and offer pharmacological treatment.
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Affiliation(s)
- Maria Duaso
- Florence Nightingale School of Nursing and Midwifery, King's College London, UK.
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