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Cohen JF, Ward KM, Gittleman J, Perez E, Pia T, Shuter J, Weinberger AH, Sulkowski M. Hepatitis C and Cigarette Smoking Behavior: Themes From Focus Groups. Nicotine Tob Res 2024; 26:1029-1037. [PMID: 38422381 DOI: 10.1093/ntr/ntae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION People with chronic hepatitis C virus (HCV; PWHC) use cigarettes at a much higher prevalence than other individuals, and smoking can exacerbate the harms specifically related to HCV (eg, hepatocellular carcinoma). Little is known about factors related to cigarette use among PWHC. AIMS AND METHODS This study examined focus group data to explore beliefs and behaviors related to cigarette use among PWHC. Qualitative data from two focus groups of PWHC reporting current cigarette smoking (n = 15, 60% male) were collected using a semi-structured interview guide. Participants were asked about reasons for smoking, barriers to quitting smoking, and the relationship of HCV to smoking. Focus groups were transcribed verbatim and coded in NVivo 12. Four coders examined themes that arose in the focus groups. Common themes are described and supported with quotes. RESULTS Reasons for smoking included addiction to cigarettes, stress, substituting cigarettes for other drugs, and social norms, while reasons for quitting included health and being free from the use of all drugs. Barriers to quitting included concerns about coping with stress, weight gain, and having a lack of support for and education about quitting. Many participants believed there was a link between smoking and HCV and discussed smoking in relation to the stress of an HCV diagnosis. CONCLUSIONS Participants identified both HCV-related and non-HCV-related aspects of cigarette smoking and cessation-related behaviors that could be targeted in cessation treatment. More research is needed to identify the best treatment approaches that reduce the significant medical consequences of cigarette use among PWHC. IMPLICATIONS People with chronic hepatitis C virus (HCV; PWHC) smoke cigarettes at a high prevalence, yet little is known about their smoking behaviors. Moreover, there are no cessation treatments targeting PWHC. This is the first study to collect focus group data from PWHC who smoke in order to identify reasons for cigarette use (HCV-related and non-HCV-related), and motivators and barriers to quitting cigarettes. PWHC reports using cigarettes to cope with the stress of an HCV diagnosis and to celebrate HCV cure. These findings suggest there are specific times during the HCV care continuum where providers can aid with cessation efforts.
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Affiliation(s)
- Julia F Cohen
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Kathleen M Ward
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jennifer Gittleman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Esther Perez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tyler Pia
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Shuter
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Abushamma S, Chen LS, Chen J, Smock N, Pham G, Chen CH. Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model. BMC Health Serv Res 2024; 24:752. [PMID: 38902682 PMCID: PMC11188289 DOI: 10.1186/s12913-024-11092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND & AIM Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.
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Affiliation(s)
- Suha Abushamma
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA.
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chien-Huan Chen
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA
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Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program. Am J Prev Med 2024; 66:435-443. [PMID: 37844710 PMCID: PMC10922402 DOI: 10.1016/j.amepre.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. METHODS This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. RESULTS Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. CONCLUSIONS Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Fahey MC, Wahlquist AE, Diaz VA, Player MS, Natale N, Sterba KR, Chen BK, Hermes EDA, Carpenter MJ, Dahne J. Rationale, design, and protocol for a hybrid type 1 effectiveness-implementation trial of a proactive smoking cessation electronic visit for scalable delivery via primary care: the E-STOP trial. BMC PRIMARY CARE 2023; 24:254. [PMID: 38030991 PMCID: PMC10685464 DOI: 10.1186/s12875-023-02205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Cigarette smoking remains the leading cause of preventable disease and death in the United States. Primary care offers an ideal setting to reach adults who smoke cigarettes and improve uptake of evidence-based cessation treatment. Although U.S. Preventive Services Task Force Guidelines recommend the 5As model (Ask, Advise, Assess, Assist, Arrange) in primary care, there are many barriers to its implementation. Automated, comprehensive, and proactive tools are needed to overcome barriers. Our team developed and preliminarily evaluated a proactive electronic visit (e-visit) delivered via the Electronic Health Record patient portal to facilitate evidence-based smoking cessation treatment uptake in primary care, with promising initial feasibility and efficacy. This paper describes the rationale, design, and protocol for an ongoing Hybrid Type I effectiveness-implementation trial that will simultaneously assess effectiveness of the e-visit intervention for smoking cessation as well as implementation potential across diverse primary care settings. METHODS The primary aim of this remote five-year study is to examine the effectiveness of the e-visit intervention vs. treatment as usual (TAU) for smoking cessation via a clinic-randomized clinical trial. Adults who smoke cigarettes are recruited across 18 primary care clinics. Clinics are stratified based on their number of primary care providers and randomized 2:1 to either e-visit or TAU. An initial baseline e-visit gathers information about patient smoking history and motivation to quit, and a clinical decision support algorithm determines the best evidence-based cessation treatment to prescribe. E-visit recommendations are evaluated by a patient's own provider, and a one-month follow-up e-visit assesses cessation progress. Main outcomes include: (1) cessation treatment utilization (medication, psychosocial cessation counseling), (2) reduction in cigarettes per day, and (3) biochemically verified 7-day point prevalence abstinence (PPA) at six-months. We hypothesize that patients randomized to the e-visit condition will have better cessation outcomes (vs. TAU). A secondary aim evaluates e-visit implementation potential at patient, provider, and organizational levels using a mixed-methods approach. Implementation outcomes include acceptability, adoption, fidelity, implementation cost, penetration, and sustainability. DISCUSSION This asynchronous, proactive e-visit intervention could provide substantial benefits for patients, providers, and primary care practices and has potential to widely improve reach of evidence-based cessation treatment. TRIAL REGISTRATION NCT05493254.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Noelle Natale
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian K Chen
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Eric D A Hermes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mathew J Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Jennifer Dahne
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
- Hollings Cancer Center, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
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Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, E F, Wang Z, Song G, Yang K, Li X, Shang W. Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med 2023; 21:378. [PMID: 37775745 PMCID: PMC10542700 DOI: 10.1186/s12916-023-03087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. METHODS A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. RESULTS A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. CONCLUSIONS The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
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Affiliation(s)
- Tao Nian
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Kangle Guo
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wendi Liu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xinxin Deng
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xiaoye Hu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Meng Xu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Fenfen E
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Ziyi Wang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Guihang Song
- Gansu Provincial Medical Security Bureau, Lanzhou, 730000, People's Republic of China
| | - Kehu Yang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xiuxia Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wenru Shang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Collaborative Innovation Center of First Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
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Salloum RG, Romani M, Bteddini DS, El-Jardali F, Lee JH, Theis R, LeLaurin JH, Hamadeh R, Osman M, Abla R, Khaywa J, Ward KD, Shelley D, Nakkash R. An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS. Implement Sci Commun 2023; 4:72. [PMID: 37365656 PMCID: PMC10294351 DOI: 10.1186/s43058-023-00456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. METHODS The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor's framework for implementation outcomes. DISCUSSION The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality. TRIAL REGISTRATION ClinicalTrials.gov, NCT05628389, Registered 16 November 2022.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dima S Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ji-Hyun Lee
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Ryan Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | | | - Mona Osman
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jihan Khaywa
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
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Gomes R, Nederveld A, Glasgow RE, Studts JL, Holtrop JS. Lung cancer screening in rural primary care practices in Colorado: time for a more team-based approach? BMC PRIMARY CARE 2023; 24:62. [PMID: 36869308 PMCID: PMC9982804 DOI: 10.1186/s12875-023-02003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. METHODS This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. RESULTS Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. CONCLUSIONS Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making.
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Affiliation(s)
- Rebekah Gomes
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Russell E Glasgow
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA.,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, and University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jodi Summers Holtrop
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
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McCarthy DE, Baker TB, Zehner ME, Adsit RT, Kim N, Zwaga D, Coates K, Wallenkamp H, Nolan M, Steiner M, Skora A, Kastman C, Fiore MC. A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design. Prev Med 2022; 165:107101. [PMID: 35636564 PMCID: PMC9990874 DOI: 10.1016/j.ypmed.2022.107101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Effective treatments for smoking cessation exist but are underused. Proactive chronic care approaches may enhance the reach of cessation treatment and reduce the prevalence of smoking in healthcare systems. This pragmatic study evaluated a population-based Comprehensive Tobacco Intervention Program (CTIP) implemented in all (6) adult primary care clinics in a Madison, Wisconsin, USA healthcare cooperative, assessing treatment reach, reach equity, and effectiveness in promoting smoking cessation. CTIP launched in 3 waves of 2 clinics each in a multiple baseline design. Electronic health record (EHR) tools facilitated clinician-delivered pharmacotherapy and counseling; guiding tobacco care managers in phone outreach to all patients who smoke; and prompting multimethod bulk outreach to all patients on a smoking registry using an opt-out approach. EHR data were analyzed to assess CTIP reach and effectiveness among 6894 adult patients between January 2018 and February 2020. Cessation treatment reach increased significantly after CTIP launch in 5 of 6 clinics and was significantly higher when clinics were active vs. inactive in CTIP [Odds Ratio (OR) range = 2.0-3.0]. Rates of converting from current to former smoking status were also higher in active vs. inactive clinics (OR range = 2.2-10.5). Telephone treatment reach was particularly high in historically underserved groups, including African-American, Hispanic, and Medicaid-eligible patients. Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access.
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Affiliation(s)
- Danielle E McCarthy
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA.
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Nayoung Kim
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Katherine Coates
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Hannah Wallenkamp
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Margaret Nolan
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Margaret Steiner
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Christian Kastman
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
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Shelley D, Wang VHC, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022; 12:1076-1083. [PMID: 36227937 PMCID: PMC9677484 DOI: 10.1093/tbm/ibac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process.
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Affiliation(s)
- Donna Shelley
- NYU School of Global Public Health, New York, NY, USA
| | | | | | | | - Benjamin Toll
- Medical University of South Carolina, Charleston, SC, USA
| | - Alana Rojewski
- Medical University of South Carolina, Charleston, SC, USA
| | - Kristie L Foley
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
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10
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Shelley D, Alvarez GG, Nguyen T, Nguyen N, Goldsamt L, Cleland C, Tozan Y, Shuter J, Armstrong-Hough M. Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study. Implement Sci Commun 2022; 3:112. [PMID: 36253834 PMCID: PMC9574833 DOI: 10.1186/s43058-022-00361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial. METHODS Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms. RESULTS The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility). CONCLUSIONS Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process. TRIAL REGISTRATION ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.
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Affiliation(s)
- Donna Shelley
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA.
| | | | - Trang Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Lloyd Goldsamt
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 7th Floor, New York, NY, USA
| | - Charles Cleland
- Grossman School of Medicine, New York University, 180 Madison Avenue, 2-53, New York, NY, 10016, USA
| | - Yesim Tozan
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA
| | - Jonathan Shuter
- Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Schiff Pavilion, Bronx, NY, USA
| | - Mari Armstrong-Hough
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA
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11
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Kowitt SD, Goldstein AO, Cykert S. A Heart Healthy Intervention Improved Tobacco Screening Rates and Cessation Support in Primary Care Practices. JOURNAL OF PREVENTION (2022) 2022; 43:375-386. [PMID: 35301643 PMCID: PMC9536240 DOI: 10.1007/s10935-022-00672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 06/03/2023]
Abstract
We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support-extracted from practices' electronic health records-and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices' tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.
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Affiliation(s)
- Sarah D Kowitt
- The Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr, 27599, Chapel Hill, NC, United States.
| | - Adam O Goldstein
- The Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr, 27599, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel Cykert
- The Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Rodríguez-Bolaños R, Ponciano-Rodríguez G, Rojas-Carmona A, Cartujano-Barrera F, Arana-Chicas E, Cupertino AP, Reynales-Shigematsu LM. Practice, barriers, and facilitators of healthcare providers in smoking cessation in Mexico. ENFERMERÍA CLÍNICA (ENGLISH EDITION) 2022; 32:184-194. [PMID: 35094967 PMCID: PMC10067257 DOI: 10.1016/j.enfcle.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the clinical practice, barriers, and facilitators in promoting smoking cessation in primary healthcare clinics in Mexico City. MATERIALS AND METHODS A mixed method design was used. Surveys (n = 70) and semi-structured interviews (n = 9) were conducted with health personnel involved in smoking cessation clinics. RESULTS Quantitative data revealed that physicians were more likely than nurses to 1) ask patients if they smoke (57.9% vs 34.5%, p = .057), 2) ask patients if they are interested in quitting smoking (65.7% vs 26.9%, p = .003), 3) provide advice to quit smoking (54.3% vs 29.2%, p = .056), and 4) assess whether pharmacotherapy is needed (21.9% vs 10%, p = .285). Qualitative data showed that nurses were more likely than physicians to report lack of resources to refer patients to smoking cessation services, lack of pharmacotherapy availability, and lack of provider training in smoking cessation. Reported barriers include lack of motivation among patients, lack of time for assessment, long appointment wait times, and lack of training. Reported facilitators include existence of smoking cessation programmes and pharmacotherapy at no cost to the patient, and having a multidisciplinary team. CONCLUSIONS Due to numerous barriers, smoking cessation interventions are partially implemented in primary care clinics in Mexico City. A restructuring of services is necessary, and nurses should be given a more prominent role.
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Pipe AL, Evans W, Papadakis S. Smoking cessation: health system challenges and opportunities. Tob Control 2022; 31:340-347. [PMID: 35241609 DOI: 10.1136/tobaccocontrol-2021-056575] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation. We argue that the provision of smoking cessation services in clinical settings is a fundamental clinical responsibility and permits the opportunity to more effectively assist with cessation. The role of clinicians in prioritising smoking cessation is essential in all settings. Clinical benefits of implementing cessation services in hospital settings have been recognised for three decades-but have not been consistently provided. The Ottawa Model for Smoking Cessation has used an 'organisational change' approach to its introduction and has served as the basis for the introduction of cessation programmes in hospital and primary care settings in Canada and elsewhere. The significance of smoking cessation dwarfs that of many preventive interventions in primary care. Compelling evidence attests to the importance of providing cessation services as part of cancer treatment, but implementation of such programmes has been slow. We recognise that the provision of such services must reflect the realities and resources of a particular health system. In low-income and middle-income countries, access to treatment facilities pose unique challenges. The integration of cessation programmes with tuberculosis control services may offer opportunities; and standardisation of peri-operative care to include smoking cessation may not require additional resources. Mobile phones afford unique opportunities for interactive cessation programming. Health system change is fundamental to improving the provision of cessation services; clinicians can be powerful advocates for such change.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - William Evans
- Department of Oncology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sophia Papadakis
- Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Crete, Greece
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14
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Patterson JG, Borger TN, Burris JL, Conaway M, Klesges R, Ashcraft A, Hauser L, Clark C, Wright L, Cooper S, Smith MC, Dignan M, Kennedy-Rea S, Paskett ED, Anderson R, Ferketich AK. A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program. Addict Sci Clin Pract 2022; 17:11. [PMID: 35164857 PMCID: PMC8842942 DOI: 10.1186/s13722-022-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. METHODS The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. DISCUSSION Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
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Affiliation(s)
- Joanne G Patterson
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Lindsay Hauser
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Connie Clark
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | | | - Sarah Cooper
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Merry C Smith
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Stephenie Kennedy-Rea
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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15
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Zijlstra DN, Hoving C, Bolman C, Muris JWM, De Vries H. Do professional perspectives on evidence-based smoking cessation methods align? A Delphi study among researchers and healthcare professionals. HEALTH EDUCATION RESEARCH 2022; 36:434-445. [PMID: 34195810 PMCID: PMC8783547 DOI: 10.1093/her/cyab022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs' needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, P.O. Box 2960, Heerlen 6401 DL, Netherlands
| | - Jean W M Muris
- Department of General Practice, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Hein De Vries
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
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16
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Shelley D, Cleland CM, Nguyen T, Van Devanter N, Siman N, Van M H, Nguyen NT. Effectiveness of a multicomponent strategy for implementing guidelines for treating tobacco use in Vietnam Commune Health Centers. Nicotine Tob Res 2021; 24:196-203. [PMID: 34543422 DOI: 10.1093/ntr/ntab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). METHODS We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n=26) in Vietnam. Arm 1 included training and a tool kit (e.g., reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As+R). Provider surveys were conducted at baseline, six- and 12-months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. RESULTS Adoption of the 4As increased significantly across both study arms (all p<.001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. CONCLUSION The study demonstrated the effectiveness of a multicomponent and multilevel strategy (i.e., provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. IMPLICATIONS Improving implementation of evidence-based tobacco dependence treatment (TDT) guidelines is a necessary step towards reducing the growing burden of non-communicable disease (NCDs) and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam, and offers a potentially scalable model for meeting FCTC Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a community health worker for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.
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Affiliation(s)
- D Shelley
- New York University School of Global Public Health, New York, NY
| | - C M Cleland
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
| | - N Van Devanter
- Rory Myers College of Nursing, New York University, New York, NY
| | - N Siman
- New York University Grossman School of Medicine, Department of Population Health, NY
| | - Hoang Van M
- Minh Hoang Van, MD, Hanoi University of Public Health, Duc Thang Ward, North Tu Liem district, Hanoi, Vietnam
| | - N T Nguyen
- Institute of Social and Medical Studies, My Dinh Ward, South Tu Liem District, Ha Noi, Vietnam
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17
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Price JW. Osteopathic model of the development and prevention of occupational musculoskeletal disorders. J Osteopath Med 2021; 121:287-305. [PMID: 33635956 DOI: 10.1515/jom-2020-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Context The direct and indirect costs of work-related musculoskeletal disorders are significant. Prevention is the most effective way to control these costs. To do that, we must understand how these disorders develop. Objectives To use the five models of osteopathic care to illustrate how cellular processes and neural reflexes interact to create work-related musculoskeletal pathology and to provide evidence-informed musculoskeletal injury and disability prevention recommendations. Methods A literature review of electronic databases (Google Scholar, PubMed, OVID, Cochrane Central Register of Controlled Trials, PEDro, and OSTMED.DR) from inception to October 16, 2019 and hand-search of publication references was performed for systematic reviews, cohort studies, case-control studies, and randomized controlled trials. The search terms reflected topics related to occupational injury and injury prevention, and included supplementary laboratory studies and narrative reviews related to the biological aspects of musculoskeletal injury. The eligible studies contained the following criteria: (1) the population of working age; (2) exposures to known risk factors, musculoskeletal disorders, and psychosocial factors; (3) written in English; (4) full text papers published in peer-reviewed journals; and (5) systematic review, cohort study, case-control study, and randomized controlled trial methodology. Studies were excluded if they included outcomes of productivity and costs only or outcomes that were assessed through qualitative methods only. Results The literature search resulted in 1,074 citations; 26 clinical studies and 14 systematic reviews were used in this review. A comprehensive workplace musculoskeletal disorder prevention program should match demands to capacity, correct dysfunctional movement patterns, and limit tissue vulnerability (biomechanical-structural model); restore alpha-gamma balance, tonic-phasic synergistic function, and autonomic balance (neurological model); maximize physiologic reserve (metabolic-energy model) component of a prevention program; optimize respiration and circulation (respiratory-circulatory model); and address cognitive distortions (behavioral-biopsychosocial model). Conclusions The presented osteopathic model of the development and prevention of work-related musculoskeletal disorders suggests that a combination of preventive interventions will be more effective than any single preventive intervention.
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Affiliation(s)
- James William Price
- Ascension St. Vincent Occupational Medicine Clinic, Evansville, IN, USA.,College of Osteopathic Medicine, Marion University, Indianapolis, IN, USA
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Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database Syst Rev 2021; 9:CD011556. [PMID: 34693994 PMCID: PMC8543670 DOI: 10.1002/14651858.cd011556.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care is an important setting in which to treat tobacco addiction. However, the rates at which providers address smoking cessation and the success of that support vary. Strategies can be implemented to improve and increase the delivery of smoking cessation support (e.g. through provider training), and to increase the amount and breadth of support given to people who smoke (e.g. through additional counseling or tailored printed materials). OBJECTIVES To assess the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings. To assess whether any effect that these interventions have on smoking cessation may be due to increased implementation by healthcare providers. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries to 10 September 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs (cRCTs) carried out in primary care, including non-pregnant adults. Studies investigated a strategy or strategies to improve the implementation or success of smoking cessation treatment in primary care. These strategies could include interventions designed to increase or enhance the quality of existing support, or smoking cessation interventions offered in addition to standard care (adjunctive interventions). Intervention strategies had to be tested in addition to and in comparison with standard care, or in addition to other active intervention strategies if the effect of an individual strategy could be isolated. Standard care typically incorporates physician-delivered brief behavioral support, and an offer of smoking cessation medication, but differs across studies. Studies had to measure smoking abstinence at six months' follow-up or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our primary outcome - smoking abstinence - was measured using the most rigorous intention-to-treat definition available. We also extracted outcome data for quit attempts, and the following markers of healthcare provider performance: asking about smoking status; advising on cessation; assessment of participant readiness to quit; assisting with cessation; arranging follow-up for smoking participants. Where more than one study investigated the same strategy or set of strategies, and measured the same outcome, we conducted meta-analyses using Mantel-Haenszel random-effects methods to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS We included 81 RCTs and cRCTs, involving 112,159 participants. Fourteen were rated at low risk of bias, 44 at high risk, and the remainder at unclear risk. We identified moderate-certainty evidence, limited by inconsistency, that the provision of adjunctive counseling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost-free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. There was also moderate-certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow-up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants). There was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies we judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty. We downgraded the evidence due to imprecision, inconsistency and risk of bias across these comparisons. There was some indication that provider training increased the delivery of smoking cessation support, along with the provision of adjunctive counseling and cost-free medications. However, our secondary outcomes were not measured consistently, and in many cases analyses were subject to substantial statistical heterogeneity, imprecision, or both, making it difficult to draw conclusions. Thirty-four studies investigated multicomponent interventions to improve smoking cessation rates. There was substantial variation in the combinations of strategies tested, and the resulting individual study effect estimates, precluding meta-analyses in most cases. Meta-analyses provided some evidence that adjunctive counseling combined with either cost-free medications or provider training enhanced quit rates when compared with standard care alone. However, analyses were limited by small numbers of events, high statistical heterogeneity, and studies at high risk of bias. Analyses looking at the effects of combining provider training with flow sheets to aid physician decision-making, and with outreach facilitation, found no clear evidence that these combinations increased quit rates; however, analyses were limited by imprecision, and there was some indication that these approaches did improve some forms of provider implementation. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing adjunctive counseling by an allied health professional, cost-free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. There is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, we rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. Further studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting. Such studies should be cluster-randomized to account for the implications of implementation in this particular setting. Due to substantial variation between studies in this review, identifying optimal characteristics of multicomponent interventions to improve the delivery of smoking cessation treatment was challenging. Future research could use component network meta-analysis to investigate this further.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gillian Pritchard
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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Rodríguez-Bolaños R, Ponciano-Rodríguez G, Rojas-Carmona A, Cartujano-Barrera F, Arana-Chicas E, Cupertino AP, Reynales-Shigematsu LM. Prácticas, barreras y facilitadores de proveedores de salud en clínicas para dejar de fumar en México. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baker TB, Berg KM, Adsit RT, Skora AD, Swedlund MP, Zehner ME, McCarthy DE, Glasgow RE, Fiore MC. Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training. Am J Prev Med 2021; 60:S113-S122. [PMID: 33663698 PMCID: PMC7939019 DOI: 10.1016/j.amepre.2019.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Patients who use tobacco are too rarely connected with tobacco use treatment during healthcare visits. Electronic health record enhancements may increase such referrals in primary care settings. This project used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the implementation of a healthcare system change carried out in an externally valid manner (executed by the healthcare system). METHODS The healthcare system used their standard, computer-based training approach to implement the electronic health record and clinic workflow changes for electronic referral in 30 primary care clinics that previously used faxed quitline referral. Electronic health record data captured rates of assessment of readiness to quit and quitline referral 4 months before implementation and 8 months (May-December 2017) after implementation. Data, analyzed from October 2018 to June 2019, also reflected intervention reach, adoption, and maintenance. RESULTS For reach and effectiveness, from before to after implementation for electronic referral, among adult patients who smoked, assessment of readiness to quit increased from 24.8% (2,126 of 8,569) to 93.2% (11,163 of 11,977), quitline referrals increased from 1.7% (143 of 8,569) to 11.3% (1,351 of 11,977), and 3.6% were connected with the quitline after implementation. For representativeness of reach, electronic referral rates were especially high for women, African Americans, and Medicaid patients. For adoption, 52.6% of staff who roomed at least 1 patient who smoked referred to the quitline. For maintenance, electronic referral rates fell by approximately 60% over 8 months but remained higher than pre-implementation rates. CONCLUSIONS Real-world implementation of an electronic health record-based electronic referral system markedly increased readiness to quit assessment and quitline referral rates in primary care patients. Future research should focus on implementation methods that produce more consistent implementation and better maintenance of electronic referral.
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Affiliation(s)
- Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Kristin M Berg
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy D Skora
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew P Swedlund
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado, Denver, Colorado
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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Siegel SD, Laurenceau J, Hill N, Bauer AM, Flitter A, Ziedonis D, Stevens N, Hosie Quinn M, Leone F, Beidas R, Kimberly J, Schnoll RA. Assessing barriers to providing tobacco use disorder treatment in community mental health settings with a revised version of the Smoking Knowledge, Attitudes, and Practices (S-KAP) instrument. Addict Behav 2021; 114:106735. [PMID: 33248743 DOI: 10.1016/j.addbeh.2020.106735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tobacco use disorder (TUD) rates are 2-3 times higher among people with serious mental illness (SMI) than the general population. Clinicians working in outpatient community mental health clinics are well positioned to provide TUD treatment to this group, but rates of treatment provision are very low. Understanding factors associated with the provision of TUD treatment by mental health clinicians is a priority. METHODS This study used baseline data from an ongoing cluster-randomized clinical trial evaluating two approaches to training clinicians to increase TUD treatment. Following a psychometric assessment of our assessment tool, the Smoking Knowledge, Attitudes, and Practices (S-KAP) instrument, a new factor structure was evaluated utilizing confirmatory factor analysis. Structural equation modeling was then used to examine the associations between TUD treatment practices and clinician, setting, and patient characteristics in a sample of 182 mental health clinicians across 10 mental health clinics. RESULTS Clinician but not setting or patient characteristics emerged as significant correlates of providing TUD treatment. Specifically, clinicians' general ethical commitment to providing TUD services and perceptions of their skills in providing this type of care were associated with providing TUD treatment. In contrast, clinician perceptions of patient motivation, anticipated quit rates, or available setting resources were not significantly associated with providing TUD treatment. CONCLUSIONS Enhancing community mental health clinician TUD treatment skills and commitment to providing such services may reduce TUD rates among people with SMI. Future studies should evaluate interventions that target these factors.
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Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc 2021; 26:778-786. [PMID: 31089727 DOI: 10.1093/jamia/ocz044] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. MATERIALS AND METHODS Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). RESULTS Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). DISCUSSION Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. CONCLUSIONS eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.
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Affiliation(s)
- Michael Fiore
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rob Adsit
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mark Zehner
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Danielle McCarthy
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Susan Lundsten
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Paul Hartlaub
- Family and Preventive Medicine, Brown Deer, Quality and Safety, Primary Care, Ascension Medical Group, Brown Deer, Wisconsin, USA
| | - Todd Mahr
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Allison Gorrilla
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Baker
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013229. [PMID: 33411338 PMCID: PMC11354481 DOI: 10.1002/14651858.cd013229.pub2] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness. OBJECTIVES To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary. METHODS This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components. MAIN RESULTS We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies. AUTHORS' CONCLUSIONS Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Okoli CTC, Otachi JK, Seng S. Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility. J Ment Health 2020; 29:631-641. [PMID: 30862266 DOI: 10.1080/09638237.2019.1581328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 10/17/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
Background: Tobacco-related morbidity and mortality is high among people with mental illnesses (PMI); yet tobacco treatment (TT) is often not provided by mental health care providers (MHPs). Studies that examine barriers to TT for people with MI are critical in addressing this disparity.Aims: To determine factors associated with MHPs' opinions of, self-efficacy in, barriers to and training needs for providing TT by job role.Methods: 205 MHPs in a psychiatric facility were surveyed using a standardized questionnaire on demographics and opinions, self-efficacy, barriers and needs to providing TT. Descriptive and multivariate regression analyses examined factors associated with the main outcomes.Results: MHP's gave high ratings to both the appropriateness of delivering evidence-based TT and their confidence in providing TT medications. In regards to perceived barriers to providing TT, MHP's further endorsed that patients should be provided nicotine replacement therapy and be motivated to engage in TT. Key needs were for training in cessation counseling, cessation materials and community support for TT.Conclusions: Based on our findings, future studies are needed to address providers' biases and concerns, eliminate system-barriers and determine effective provider training. Moreover, these findings may guide research, practice and policies toward enhancing TT in PMI.
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Affiliation(s)
| | - Janet K Otachi
- Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - Sarret Seng
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Martin-Cantera C, Sanmartín JMI, Martínez AF, Lorenzo CM, Cohen VB, Jiménez MLC, Pérez-Teijón SC, Osca JARI, García RC, Fernández JL, Domenech MAG, Navascues MAM, Chaves ES, Ibañez MLR, Rubio VG, Rayo SM, Otero BM, Lopez LG, Guillem FC, Fuente FM, Ruiz DB, Rodríguez AIH, Caballero JDDG, Moreno CB, Pubil MP, Grau ML. Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses. Tob Prev Cessat 2020; 6:55. [PMID: 33083683 PMCID: PMC7552853 DOI: 10.18332/tpc/126630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior. METHODS A cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge. RESULTS Of the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2–2.5) or ex-smoker (OR=1.4; 95% CI: 1.02–2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3–2.4) and training (OR=2.4; 95% CI: 1.8–3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03–1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03–1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training. CONCLUSIONS The GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required.
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Affiliation(s)
- Carlos Martin-Cantera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Grupo Abordaje al Tabaquismo SemFYC, Barcelona, Spain
| | - Jose M Iglesias Sanmartín
- Unidad Especializada de Tabaquismo del Área Sanitaria IV del Principado de Asturias, Asturias, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Diego Beni Ruiz
- Consultorio de Aldeanueva de Ebro, Centro de Salud Alfaro, La Rioja, Spain
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Dahne J, Player M, Carpenter MJ, Ford DW, Diaz VA. Evaluation of a Proactive Smoking Cessation Electronic Visit to Extend the Reach of Evidence-Based Cessation Treatment via Primary Care. Telemed J E Health 2020; 27:347-354. [PMID: 33085578 DOI: 10.1089/tmj.2020.0167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Best practice guidelines for smoking cessation treatment through primary care advise the 5As model. However, compliance with these guidelines is poor, leaving many smokers untreated. The purpose of this study was to develop and preliminarily evaluate an asynchronous smoking cessation electronic visit (e-visit) that could be delivered proactively through the electronic health record (EHR) to adult smokers treated within primary care. The goal of the e-visit is to automate 5As delivery to ensure that all smokers receive evidence-based cessation treatment. As such, the aims of this study were twofold: (1) to examine acceptability, feasibility, and treatment metrics associated with e-visit utilization and (2) to preliminarily examine efficacy relative to treatment as usual (TAU) within primary care. Methods: Participants (n = 51) were recruited from primary care practices between November 2018 and October 2019 and randomized 2:1 to receive either the smoking cessation e-visit or TAU. Participants completed assessments of cessation outcomes 1-month and 3-months postenrollment and e-visit analytics data were gathered from the EHR. Results: Self-report feedback from e-visit participants indicated satisfaction with the intervention and interest in using e-visits again in the future. Nearly all e-visits resulted in prescription of a U.S. Food and Drug Administration (FDA)-approved smoking cessation medication. In general, smoking cessation outcomes favored the e-visit condition at both 1 (odds ratios [ORs]: 2.10-5.39) and 3 months (ORs: 1.31-4.67). Conclusions: These results preliminarily indicate the feasibility, acceptability, and efficacy of this smoking cessation e-visit within primary care. Future studies should focus on larger scale examination of effectiveness and implementation across settings. The clinicaltrials.gov registration number for this trial is NCT04316260.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marty Player
- Department of Family Medicine,Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, and Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa A Diaz
- Department of Family Medicine,Medical University of South Carolina, Charleston, South Carolina, USA
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VanDevanter N, Vu M, Nguyen A, Nguyen T, Van Minh H, Nguyen NT, Shelley DR. A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers. Implement Sci 2020; 15:73. [PMID: 32907603 PMCID: PMC7488010 DOI: 10.1186/s13012-020-01035-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. Methods We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. Results Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. Conclusion Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users. Trial registration NCT02564653, registered September 2015
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Affiliation(s)
- Nancy VanDevanter
- Rory Myers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ann Nguyen
- Department of Population Health, NYU Langone Health, 180 Madison Ave., 17th floor, New York, NY, 10016, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Hoang Van Minh
- Hanoi University of Public Health, No 1A Duc Thang Street, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Nam Truong Nguyen
- Institute of Social and Medical Studies, 810 CT1A ĐN1, Ham Nghi Street, My Dinh 2 Ward, South Tu Liem District, Hanoi, Vietnam
| | - Donna R Shelley
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10012, USA.
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Neil JM, Price SN, Friedman ER, Ponzani C, Ostroff JS, Muzikansky A, Park ER. Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients. Tob Use Insights 2020; 13:1179173X20949270. [PMID: 32874095 PMCID: PMC7436840 DOI: 10.1177/1179173x20949270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.
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Affiliation(s)
- J M Neil
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - S N Price
- University of Arizona, Tucson, AZ, USA
| | | | - C Ponzani
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - J S Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - A Muzikansky
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - E R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
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Dahne J, Wahlquist AE, Smith TT, Carpenter MJ. The differential impact of nicotine replacement therapy sampling on cessation outcomes across established tobacco disparities groups. Prev Med 2020; 136:106096. [PMID: 32320705 PMCID: PMC7255419 DOI: 10.1016/j.ypmed.2020.106096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/15/2022]
Abstract
Cigarette smoking is increasingly concentrated among marginalized populations with limited access to evidence-based cessation treatment. This includes racial/ethnic minorities, lower income individuals, those with lower educational attainment, and residents of rural areas. To reach Healthy People 2020 objectives, successful cessation interventions must narrow these disparities. Nicotine replacement therapy (NRT) sampling is an easily translatable and scalable intervention that could enhance treatment access and thus narrow disparities. The present study examined individual-level demographic moderators of the impact of NRT sampling on cessation-related behaviors including: 1) use of a cessation medication, 2) making a 24-hour quit attempt, 3) floating abstinence, and 4) 7-day point prevalence abstinence at 6-months. Study participants included N = 1245 adult smokers enrolled in the Tobacco Intervention in Primary Care Treatment Opportunities for Providers (TIP TOP) study, a recently concluded large-scale clinical trial of NRT sampling relative to standard care within 22 primary care clinics across South Carolina. Generalized linear models examined individual-level demographic moderators of treatment effect. Results suggest that NRT sampling may be more effective among some of the most disadvantaged groups of smokers, including smokers with lower income and education, as well those who live in more rural areas. The effects of NRT sampling did not differ by race. In sum, NRT sampling is a low-cost, low-burden intervention that could be disseminated broadly to reach large numbers of smokers and potentially narrow cessation disparities.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA
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Shelley DR, Kyriakos C, McNeill A, Murray R, Nilan K, Sherman SE, Raw M. Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis. Addiction 2020; 115:527-533. [PMID: 31777107 DOI: 10.1111/add.14863] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/30/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Abstract
AIM To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). DESIGN Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. SETTING AND PARTICIPANTS Survey respondents (n = 127 countries) who completed an open-ended question on the 26-item survey. MEASUREMENTS The open-ended question asked the following: 'In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?'. We conducted thematic analysis of the responses. FINDINGS The most frequently reported barriers included a lack of health-care system infrastructure (n = 86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n = 66) and lack of funding (n = 51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n = 11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n = 5), public norms supporting tobacco use (n = 11), a lack of health-care leadership and expertise in the area of TDT (n = 6) and a lack of grassroots and multi-sector networks supporting policy implementation (n = 8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. CONCLUSION Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding.
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Affiliation(s)
- Donna R Shelley
- New York University College of Global Public Health, New York, NY, USA
| | | | | | - Rachael Murray
- Division of Epidemiology and Public Health/UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
| | - Kapka Nilan
- Division of Epidemiology and Public Health/UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
| | - Scott E Sherman
- New York University College of Global Public Health, New York, NY, USA
| | - Martin Raw
- International Centre for Tobacco Cessation, London, UK.,College of Global Public Health, New York University, NY, USA
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31
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Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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32
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Jiang N, Siman N, Cleland CM, Van Devanter N, Nguyen T, Nguyen N, Shelley D. Effectiveness of Village Health Worker-Delivered Smoking Cessation Counseling in Vietnam. Nicotine Tob Res 2019; 21:1524-1530. [PMID: 30335180 PMCID: PMC6941703 DOI: 10.1093/ntr/nty216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. METHODS We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). RESULTS At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p < .001). In multivariate analyses, smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR] = 2.96, 95% confidence interval [CI] = 1.78% to 4.92%). Compared to cigarette-only smokers, water pipe-only smokers (AOR = 0.4, 95% CI = 0.26% to 0.62%) and dual users (AOR = 0.62, 95% CI = 0.45% to 0.86%) were less likely to achieve abstinence; however, the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. CONCLUSION A team approach in TDT programs that offer a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in low middle-income countries (LMICs). TDT programs may need to adapt interventions to improve outcomes for water pipe users. IMPLICATIONS The study fills literature gaps on effective models for TDT in LMICs. The addition of VHW-led cessation counseling, available through a referral from primary care providers in CHCs in Vietnam, to health care provider's brief cessation advice, increased 6-month biochemically validated abstinence rates compared to provider advice alone. The study also demonstrated the potential effectiveness of VHW counseling on reducing water pipe use. For LMICs, TDT programs in primary care settings with a referral system to VHW-led cessation counseling might be a promising and potentially scalable model for increasing access to evidence-based treatment.
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Affiliation(s)
- Nan Jiang
- Department of Population Health, New York University, New York, NY
| | - Nina Siman
- Department of Population Health, New York University, New York, NY
| | | | | | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Donna Shelley
- Department of Population Health, New York University, New York, NY
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Suárez-Varela Úbeda JF, Rodríguez-Vázquez S, Ordóñez Barranco JA, Vega Caldera G, Pérez Alvárez PP, Buitrago F. Effectiveness of individual and group multicomponent interventions for smoking cessation in primary care: a quasi-experimental study. Fam Pract 2019; 36:627-633. [PMID: 30772892 DOI: 10.1093/fampra/cmz005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice. OBJECTIVE To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices. METHODS A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients. RESULTS The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065-3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006-3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126-4.980, P < 0.05) were significantly associated with smoking cessation. CONCLUSIONS Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment.
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Affiliation(s)
| | | | | | | | | | - Francisco Buitrago
- Servicio Extremeño de Salud, Centro de Salud Universitario 'La Paz', Unidad Docente de Medicina Familiar y Comunitaria, Departamento de Ciencias Biomédicas, Universidad de Extremadura, Badajoz, Spain
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Wray JM, Funderburk JS, Acker JD, Wray LO, Maisto SA. A Meta-Analysis of Brief Tobacco Interventions for Use in Integrated Primary Care. Nicotine Tob Res 2019; 20:1418-1426. [PMID: 29059419 DOI: 10.1093/ntr/ntx212] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 11/14/2022]
Abstract
Introduction The integration of behavioral health services in primary care settings presents an opportunity to enhance the delivery of tobacco cessation interventions in the primary care setting, but guidance on evidence-based treatments for tobacco use disorder that fits the brief format of integrated primary care (IPC) is limited. This meta-analysis summarizes the outcomes of brief behavioral interventions targeting tobacco use that can be delivered in IPC settings. Methods A literature search was conducted to locate empirical studies examining tobacco cessation interventions that could be implemented in an IPC setting. A random effects meta-analytic approach was utilized with odds ratios as the effect size. Subgroup analyses were conducted to determine the extent to which a number of study, participant, and intervention characteristics affected treatment outcome. Results A total of 36 studies were included (n = 12975 patients). Patients in the intervention groups exhibited significantly greater odds of smoking cessation compared with those in the comparison groups (OR = 1.78, p < .001). Subgroup analyses did not reveal significant sources of heterogeneity attributable to moderators such as methodological quality, gender, bioverification, follow-up time period, or intervention characteristics (such as setting, type, or length of intervention). Conclusions Brief tobacco cessation interventions that can be delivered in IPC settings were found to be effective. Future research in this area might evaluate ways to improve the dissemination and implementation of these types of interventions in IPC settings. Implications The integration of behavioral health services into primary care presents a unique opportunity to increase the delivery of tobacco cessation interventions, as behavioral health providers in these settings are experts in behavior change interventions and may have more time to deliver these interventions than primary care providers. Results from the current meta-analysis demonstrate that brief tobacco cessation interventions that can be implemented in the IPC setting are effective. Future research in this area might examine ways to improve the dissemination and implementation of brief interventions for tobacco use in IPC settings.
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Affiliation(s)
- Jennifer M Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC.,VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY.,Department of Psychiatry, University of Rochester, Rochester, NY
| | - John D Acker
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Division of Geriatrics and Palliative Medicine, University at Buffalo, Buffalo, NY.,Department of Psychology, University at Buffalo, Buffalo, NY
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY
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35
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Santos MDDV, Santos SV, Caccia-Bava MDCGG. [The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:563-572. [PMID: 30726388 DOI: 10.1590/1413-81232018242.27712016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.
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Affiliation(s)
- Meire de Deus Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
| | - Stella Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
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Li L, Lee JH, Sutton SK, Simmons VN, Brandon TH. A Bayesian transition model for missing longitudinal binary outcomes and an application to a smoking cessation study. STAT MODEL 2019; 20:310-338. [PMID: 33854408 DOI: 10.1177/1471082x18821489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Smoking cessation intervention studies often produce data on smoking status at discrete follow-up assessments, often with missing data in different amounts at each assessment. Smoking status in these studies is a dynamic process with individuals transitioning from smoking to abstinent, as well as abstinent to smoking, at different times during the intervention. Directly assessing transitions provides an opportunity to answer important questions like 'Does the proposed intervention help smokers remain abstinent or quit smoking more effectively than other interventions?' In this article, we model changes in smoking status and examine how interventions and other covariates affect the transitions. We propose a Bayesian approach for fitting the transition model to the observed data and impute missing outcomes based on a logistic model, which accounts for both missing at random (MAR) and missing not at random (MNAR) mechanisms. The proposed Bayesian approach treats missing data as additional unknown quantities and samples them from their posterior distributions. The performance of the proposed method is investigated through simulation studies and illustrated by data from a randomized controlled trial of smoking cessation interventions. Finally, posterior predictive checking and log pseudo marginal likelihood (LPML) are used to assess model assumptions and perform model comparisons, respectively.
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Affiliation(s)
- Li Li
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center; Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behaviour, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behaviour, Moffitt Cancer Center, Tampa, FL, USA
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37
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Pagano A, Gubner NR, Le T, Yip D, Williams D, Delucchi K, Guydish J. Differences in tobacco use prevalence, behaviors, and cessation services by race/ethnicity: A survey of persons in addiction treatment. J Subst Abuse Treat 2018; 94:9-17. [PMID: 30243423 PMCID: PMC6203319 DOI: 10.1016/j.jsat.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Disparities in tobacco use prevalence, behaviors, and services have been identified among people of different racial and ethnic groups in the United States general population. Persons in addiction treatment have among the highest smoking prevalence of any population. However, little is known about racial and ethnic disparities in tobacco use prevalence, behaviors, and services among persons in addiction treatment. METHODS Survey data were used from 1840 clients from 24 addiction treatment programs from the NIDA Clinical Trials Network. Multivariate regression analyses were conducted to assess associations between race/ethnicity (White, African American, Hispanic) and patterns of tobacco and other tobacco product use, as well as quitting behaviors and receipt of tobacco cessation services among current smokers (n = 1425) while in treatment. RESULTS There was no difference in cigarette smoking prevalence across racial/ethnic groups. In the multivariate models, Hispanics and African Americans, compared to Whites, were less likely to be daily smokers, use smokeless tobacco, or use e-cigarettes. African Americans and Hispanics reported more past-year quit attempts and higher use of menthol compared to Whites. Hispanics were more interested in quitting while in treatment than Whites. Contrary to expectations, African Americans reported receiving more tobacco cessation advice and services while in treatment than Whites. CONCLUSIONS Some findings reflected broader population patterns (e.g., tobacco use behaviors, other tobacco product use), while others did not (e.g., no difference in tobacco use prevalence by race/ethnicity). The reasons for greater receipt of cessation services among African Americans are unclear. Findings indicate the need for continued engagement of African Americans and Hispanics in cessation services while in addiction treatment, and for addressing heavier tobacco use and lack of interest in cessation during treatment among White clients.
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Affiliation(s)
- Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Ave, Suite 601, Berkeley, CA 94704, United States of America.
| | - Noah R Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, United States of America
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, United States of America
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, United States of America
| | - Denise Williams
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, United States of America
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, United States of America
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94118, United States of America
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Papadakis S, Cole AG, Reid RD, Assi R, Gharib M, Tulloch HE, Mullen KA, Wells G, Pipe AL. From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates. Ann Fam Med 2018; 16:498-506. [PMID: 30420364 PMCID: PMC6231943 DOI: 10.1370/afm.2312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians. METHODS In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (Ask, Advise, Assist, Arrange) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up. RESULTS Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for Ask (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), Assist (AOR = 1.64; 95% CI, 1.08-2.49), and Arrange (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for Advise was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; P = .02). No differences were documented between groups for cessation outcomes. CONCLUSIONS Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.
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Affiliation(s)
- Sophia Papadakis
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinic of Social and Family Medicine, University of Crete, Rethymnon, Crete, Greece
| | - Adam G Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Roxane Assi
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marie Gharib
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Dahne J, Wahlquist AE, Boatright AS, Garrett-Mayer E, Fleming DO, Davis R, Egan B, Carpenter MJ. Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial. Contemp Clin Trials 2018; 72:1-7. [PMID: 30010086 PMCID: PMC6133738 DOI: 10.1016/j.cct.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary care is the most important point of healthcare contact for smokers. Brief physician advice to quit, based on the 5As/AAR model, offers some efficacy but is inconsistently administered and has limited population impact. Nicotine replacement therapy (NRT) sampling, defined as provision of a brief NRT starter kit, when added to the 5As/AAR, is well-suited to primary care because it is simple, brief, and can be provided to all smokers. This article describes the design and methods of an ongoing comparative effectiveness trial testing standard care vs. standard care + NRT sampling within primary care. METHODS Smokers were recruited directly from primary care practices between July 2014 and December 2017 within an established network of South Carolina clinics. Interventions were delivered randomly by clinic personnel, and phone-based follow-ups were centrally coordinated by research staff to track outcomes through six months post-intervention. Primary study aims are to examine the impact of NRT sampling on smoking, inclusive of cessation, quit attempts, and uptake of evidence-based treatment. RESULTS Twenty-two clinics were recruited. Across clinics, patient census ranged from 985 to 10,957 and number of providers ranged from 1 to 63. Average patient age across clinics was 52.9 years and smoking prevalence across ranged from 10.6% to 28.5%. CONCLUSION Improving the effectiveness and reach of brief interventions within primary care could have a considerable impact on population quit rates. We consider the advantages and disadvantages of key methodological decisions relevant to the design of future primary care-based cessation trials.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Amy S Boatright
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Douglas O Fleming
- Care Coordination Institute, Greenville, SC, USA; Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Robert Davis
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Brent Egan
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
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Chen LS, Baker TB, Korpecki JM, Johnson KE, Hook JP, Brownson RC, Bierut LJ. Low-Burden Strategies to Promote Smoking Cessation Treatment Among Patients With Serious Mental Illness. Psychiatr Serv 2018; 69:849-851. [PMID: 29852824 PMCID: PMC6280191 DOI: 10.1176/appi.ps.201700399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with serious mental illness have high smoking prevalence and early mortality. Inadequate implementation of evidence-based smoking cessation treatment in community mental health centers (CMHCs) contributes to this disparity. This column describes a study of the effects of quality improvement strategies on treatment and cessation outcomes among patients with serious mental illness at four CMHCs. Two low-burden strategies, decision support and academic detailing with data-driven feedback, were implemented in the CMHCs' clinics from 2014 to 2016. Pre- and postimplementation data from pharmacy and medical records were analyzed. The percentage of patients receiving cessation medication increased from 5% to 18% (p≤.001), and smoking prevalence decreased from 57% to 54% (p≤.001). This quality improvement approach holds great potential for increasing the level of smoking cessation care for patients treated in CMHC settings. Decision support and academic detailing with feedback may be effective strategies to promote best practices.
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Affiliation(s)
- Li-Shiun Chen
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Timothy B Baker
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Jeanette M Korpecki
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Kelly E Johnson
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Jaime P Hook
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Ross C Brownson
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Laura J Bierut
- Dr. Chen, Dr. Brownson, and Dr. Bierut are with the Siteman Cancer Center and Institute of Public Health Sciences, and Dr. Chen and Dr. Bierut are also with the Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis. Dr. Brownson is also with the School of Social Work, Washington University in St. Louis. Dr. Baker is with the Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Dr. Korpecki, Dr. Johnson, and Dr. Hook are with BJC Behavioral Health, BJC Healthcare, St. Louis. Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
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Peleki T, Girvalaki C, Lozano F, Radu-Loghin C, Nguyen D, Harutyunyan A, Bakhturidze G, Trofor A, Demin A, Stoyka O, Tsiou C, Papadakis S, Vardavas CI, Behrakis PK. Short-term impact of the EuroPean Accredited Curriculum on Tobacco Treatment Training (EPACTT) program. Tob Prev Cessat 2018; 4:28. [PMID: 32411854 PMCID: PMC7205079 DOI: 10.18332/tpc/92484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers' knowledge, attitudes and self-efficacy related to tobacco dependence treatment. METHODS A pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program. RESULTS In all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers' self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed. CONCLUSIONS The results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.
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Affiliation(s)
- Theodosia Peleki
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Medicine, Athens, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Francisco Lozano
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Cornel Radu-Loghin
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Dominick Nguyen
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | | | | | - Antigona Trofor
- University of Medicine and Pharmacy ‘Grigore T.Popa’, Iasi, Romania
| | - Andrey Demin
- Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University under the Ministry of Health of the Russian Federation, Russia
| | | | | | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Institute of Public Health, American College of Greece, George D Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
| | - Panagiotis K. Behrakis
- Institute of Public Health, American College of Greece, Athens, Greece
- George D Behrakis Research Lab, Hellenic Cancer Society, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Girvalaki C, Papadakis S, Vardavas C, Pipe AL, Petridou E, Tsiligianni I, Lionis C. Training General Practitioners in Evidence-Based Tobacco Treatment: An Evaluation of the Tobacco Treatment Training Network in Crete (TiTAN-Crete) Intervention. HEALTH EDUCATION & BEHAVIOR 2018; 45:888-897. [PMID: 29862845 DOI: 10.1177/1090198118775481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rates of tobacco treatment delivery in primary care are suboptimal. AIMS We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner's (GP) knowledge, attitudes, self-efficacy, and intentions. METHODS A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data. RESULTS Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45]). CONCLUSION We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.
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Affiliation(s)
| | - Sophia Papadakis
- 1 University of Crete, Heraklion, Greece.,2 University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,3 University of Ottawa, Ottawa, Ontario, Canada
| | | | - Andrew L Pipe
- 2 University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,3 University of Ottawa, Ottawa, Ontario, Canada
| | - Eleni Petridou
- 4 National and Kapodistrian University of Athens, Athens, Greece
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Girvalaki C, Papadakis S, Vardavas C, Petridou E, Pipe A, Lionis C. Smoking cessation delivery by general practitioners in Crete, Greece. Eur J Public Health 2018; 28:542-547. [PMID: 29140450 DOI: 10.1093/eurpub/ckx201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Tobacco dependence treatment in clinical settings is of prime public health importance, especially in Greece, a country experiencing one of the highest rates of tobacco use in Europe. Methods Our study aimed to examine the characteristics of tobacco users and document rates of tobacco treatment delivery in general practice settings in Crete, Greece. A cross-sectional sample of patients (n = 2, 261) was screened for current tobacco use in 25 general practices in Crete, Greece in 2015/16. Current tobacco users completed a survey following their clinic appointment that collected information on patient characteristics and rates at which the primary care physician delivered tobacco treatment using the evidence-based 4 A's (Ask, Advise, Assist, Arrange) model during their medical appointment and over the previous 12-month period. Multi-level modeling was used to analyze data and examine predictors of 4 A's delivery. Results Tobacco use prevalence was 38% among all patients screened. A total of 840 tobacco users completed the study survey [mean age 48.0 (SD 14.5) years, 57.6% male]. Approximately, half of the tobacco users reported their general practitioner 'asked' about their tobacco use and 'advised' them to quit smoking. Receiving 'assistance' with quitting (15.7%) and 'arranging' follow-up support (<3%) was infrequent. Patient education, presence of smoking-related illness, a positive screen for anxiety or depression and the type of medical appointment were associated with 4 A's delivery. Conclusion Given the fundamental importance of addressing tobacco treatment, increasing the rates of 4 A's treatment in primary care settings in Greece is an important target for improving patient care.
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Affiliation(s)
- Charis Girvalaki
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
| | - Sophia Papadakis
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Constantine Vardavas
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
| | - Eleni Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christos Lionis
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
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Papadakis S, Girvalaki C, Vardavas C, Pipe AL, Cole A, Tsiligianni I, Petridou E, Lionis C. Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention? Tob Induc Dis 2018; 16:21. [PMID: 31516421 PMCID: PMC6659564 DOI: 10.18332/tid/90822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece. METHODS We conducted a secondary analysis of data derived from a quasi-experimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery. RESULTS Our analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination. CONCLUSIONS Providers are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.
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Affiliation(s)
- Sophia Papadakis
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Charis Girvalaki
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Constantine Vardavas
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Adam Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Eleni Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
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Fehily C, Bartlem K, Wiggers J, Wolfenden L, Regan T, Dray J, Bailey J, Bowman J. Systematic review of interventions to increase the provision of care for chronic disease risk behaviours in mental health settings: review protocol. Syst Rev 2018; 7:67. [PMID: 29712561 PMCID: PMC5928577 DOI: 10.1186/s13643-018-0735-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/20/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND People with a mental illness experience a higher morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of risk behaviours, including tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity, is a substantial contributor to this health inequity. Clinical practice guidelines recommend that mental health services routinely provide care to their clients to address these risk behaviours. Such care may include the following elements: ask, assess, advise, assist and arrange (the '5As'), which has been demonstrated to be effective in reducing risk behaviours. Despite this potential, the provision of such care is reported to be low internationally and in Australia, and there is a need to identify effective strategies to increase care provision. The proposed review will examine the effectiveness of interventions which aimed to increase care provision (i.e. increase the proportion of clients receiving or clinicians providing the 5As) for the chronic disease risk behaviours of clients within the context of mental health service delivery. METHODS Eligible studies will be any quantitative study designs with a comparison group and which report on the effectiveness of an intervention strategy (including delivery arrangements, financial arrangements, governance arrangements and implementation strategies) to increase care provision specifically for chronic disease risk behaviours (tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity). Screening for studies will be conducted across seven electronic databases: PsycINFO, MEDLINE, Excerpta Medica database (EMBASE), Psychology and Behavioural Sciences Collection, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors will independently screen studies for eligibility and extract data from included studies. Where studies are sufficiently homogenous, meta-analysis will be performed. Where considerable heterogeneity exists (I 2 ≥ 75), narrative synthesis will be used. DISCUSSION This review will be the first to synthesise evidence for the effectiveness of intervention approaches to facilitate care provision for chronic disease risk behaviours in the context of mental health service delivery. The results have the potential to inform the development of evidenced-based approaches to address the health inequities experienced by this population group. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074360 .
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Affiliation(s)
- Caitlin Fehily
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Kate Bartlem
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - John Wiggers
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Luke Wolfenden
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Timothy Regan
- The University of Newcastle, Callaghan, NSW Australia
| | - Julia Dray
- The University of Newcastle, Callaghan, NSW Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jacqueline Bailey
- The University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Jenny Bowman
- The University of Newcastle, Callaghan, NSW Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
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Trofor AC, Papadakis S, Vardavas CI, Lotrean LM, Gavrilescu CM, Evangelopoulou V, Peleki T, Trofor L, Behrakis PK. Impact of the Tobacco Treatment Guidelines for High Risk Groups (TOB.g): A pilot study among physicians specializing in CVD, Diabetes and COPD. Tob Prev Cessat 2018; 4:13. [PMID: 32411841 PMCID: PMC7205041 DOI: 10.18332/tpc/87090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, self-efficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes. METHODS A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training. RESULTS Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy. CONCLUSIONS Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.
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Affiliation(s)
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Constantine I Vardavas
- Institute of Public Health, American College of Greece, Athens, Greece
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | | | - Vaso Evangelopoulou
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Theodosia Peleki
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
| | - Letitia Trofor
- University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Panagiotis K Behrakis
- Institute of Public Health, American College of Greece, Athens, Greece
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
- Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
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Bailey SR, Stevens VJ, Fortmann SP, Kurtz SE, McBurnie MA, Priest E, Puro J, Solberg LI, Schweitzer R, Masica AL, Hazlehurst B. Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care. Am J Health Promot 2018. [PMID: 29534598 DOI: 10.1177/0890117118761886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To test the association between repeated clinical smoking cessation support and long-term cessation. DESIGN Retrospective, observational cohort study using structured and free-text data from electronic health records. SETTING Six diverse health systems in the United States. PARTICIPANTS Patients aged ≥18 years who were smokers in 2007 and had ≥1 primary care visit in each of the following 4 years (N = 33 691). MEASURES Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, and ≥75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for ≥365 days following a visit where nonsmoker or former smoker was indicated. ANALYSIS Mixed effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation. RESULTS Overall, 20% of the cohort achieved LTQ status. Patients with ≥75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types. CONCLUSIONS These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.
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Affiliation(s)
- Steffani R Bailey
- 1 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Victor J Stevens
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen E Kurtz
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | | | | | - Rebecca Schweitzer
- 6 Department is Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI, USA
| | | | - Brian Hazlehurst
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
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Reid RD, Malcolm J, Wooding E, Geertsma A, Aitken D, Arbeau D, Blanchard C, Gagnier JA, Gupta A, Mullen KA, Oh P, Papadakis S, Tulloch H, LeBlanc AG, Wells GA, Pipe AL. Prospective, Cluster-Randomized Trial to Implement the Ottawa Model for Smoking Cessation in Diabetes Education Programs in Ontario, Canada. Diabetes Care 2018; 41:406-412. [PMID: 29269509 DOI: 10.2337/dc17-1809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether a practice-level intervention to promote the systematic identification, treatment, and follow-up of smokers (the Ottawa Model for Smoking Cessation [OMSC]) would improve long-term abstinence rates among smoker-patients with type 2 diabetes or prediabetes receiving care from diabetes education programs in Ontario, Canada. RESEARCH DESIGN AND METHODS The Tobacco Intervention in Diabetes Education study was a matched-pair, cluster-randomized clinical trial. Within each pair, sites were randomly allocated to either an OMSC intervention (n = 7) or a wait-list control (WLC) condition (n = 7). Diabetes education programs in the OMSC group introduced standardized processes to identify smokers and routinely provided smoking cessation interventions and follow-up. Smokers in the OMSC group received counseling, a discount card to partially cover the cost of smoking cessation medication, and follow-up telephone calls over a 6-month period. Diabetes education programs in the WLC condition were offered the OMSC intervention after a 1-year waiting period. Smokers in the WLC group received usual care for smoking cessation from their diabetes educator. The primary end point was carbon monoxide (CO)-confirmed 7-day point prevalence abstinence from smoking at 6-month follow-up. RESULTS A total of 313 smokers (OMSC group n = 199, WLC group n = 114) with diabetes or prediabetes were enrolled. The CO-confirmed abstinence rate at 6 months was 11.1% in the OMSC group versus 2.6% in the WLC group (odds ratio 3.73 [95% CI 1.20, 11.58]; P = 0.02). CONCLUSIONS Implementation of the OMSC in diabetes education programs resulted in clinically and statistically significant improvements in long-term abstinence among smokers with diabetes or prediabetes.
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Affiliation(s)
- Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janine Malcolm
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Evyanne Wooding
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Amy Geertsma
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Debbie Aitken
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Arbeau
- Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jo-Anne Gagnier
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anil Gupta
- Trillium Health Centre, Mississauga, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Allana G LeBlanc
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Hummel K, Nagelhout GE, Fong GT, Vardavas CI, Papadakis S, Herbeć A, Mons U, van den Putte B, Borland R, Fernández E, de Vries H, McNeill A, Gravely S, Przewoźniak K, Kovacs P, Trofor AC, Willemsen MC. Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018; 16:A6. [PMID: 31363422 PMCID: PMC6659556 DOI: 10.18332/tid/98912] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country. METHODS Cross-sectional data were collected in 2016 from 10,683 smokers in eight European countries participating in the ITC Project: England (n=3,536), Germany (n=1,003), Greece (n=1,000), Hungary (n=1,000), the Netherlands (n=1,136), Poland (n=1,006), Romania (n=1,001), and Spain (n=1,001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e., medication, quitlines, internet, local services, and e-cigarettes), and whether respondents had received advice about quitting and e-cigarettes from health professionals. RESULTS Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet-based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity. CONCLUSIONS Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.
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Affiliation(s)
- Karin Hummel
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Gera E. Nagelhout
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- IVO Research Institute, The Hague, the Netherlands
| | - Geoffrey T. Fong
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- University of Crete (UoC), Heraklion, Greece
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Sophia Papadakis
- University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Aleksandra Herbeć
- Health Promotion Foundation, Warsaw, Poland
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Catalonia, Spain
- School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Piroska Kovacs
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
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Lum A, Skelton E, Wynne O, Bonevski B. A Systematic Review of Psychosocial Barriers and Facilitators to Smoking Cessation in People Living With Schizophrenia. Front Psychiatry 2018; 9:565. [PMID: 30459658 PMCID: PMC6232499 DOI: 10.3389/fpsyt.2018.00565] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background: People living with schizophrenia are less likely to quit smoking compared with the general population and people living with other psychiatric disorders. Understanding the schizophrenia-specific psychosocial barriers and facilitators to smoking cessation is important for designing effective smoking cessation interventions. We aimed to systematically review research examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. Methods: We followed the PRISMA statement to conduct a systematic literature review examining psychosocial barriers and facilitators to smoking cessation in people living with schizophrenia. We searched EMBASE, Medline, PsycINFO, and CINAHL databases from inception to 14 June 2018 to identify relevant articles. We included peer-reviewed original research articles that examined psychosocial barriers and facilitators to smoking cessation, as well as factors associated with maintenance of smoking habits in people living with schizophrenia spectrum disorders. Qualitative, quantitative, or mixed-methods study designs were included. Three authors screened titles, abstracts, and full-texts using the eligibility criteria. We conducted a narrative synthesis of the data to account for the heterogeneity of study designs. We analyzed qualitative and quantitative studies separately. Results: We identified 685 studies from our systematic search and screened the full-text of 134 articles. The final set of 23 articles included 20 quantitative studies and 3 qualitative studies. The most commonly cited barrier to smoking cessation in people living with schizophrenia was cravings and addiction, followed by a perceived increased risk of negative affect associated with quitting smoking. People living with schizophrenia reported smoking to manage stress and to maintain social relationships. People living with schizophrenia were found to be less likely to receive cessation support from health professionals than smokers without schizophrenia. Health concerns were the most commonly mentioned facilitator to quit smoking. Conclusions: People living with schizophrenia experience a wide range of barriers to smoking cessation. The influence of these barriers on smoking cessation likelihood may be greater among people living with schizophrenia than people without psychiatric disorders. Health professionals play an important role in smoking cessation for people living with schizophrenia and should consider barriers and facilitators identified in this review to support quitting in this vulnerable population.
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Affiliation(s)
- Alistair Lum
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Eliza Skelton
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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