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Jongebloed H, Cole E, Dean E, Ugalde A. The role of general practice nurses in supporting people to quit smoking: A qualitative study. PLoS One 2024; 19:e0306555. [PMID: 39024273 PMCID: PMC11257311 DOI: 10.1371/journal.pone.0306555] [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: 10/18/2023] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE Encounters with General Practitioners (GPs) have previously been identified as opportune for the delivery of smoking cessation care however the role of nurses in general practice settings is unclear. This study aimed to understand how nurses are providing smoking cessation care in general practice. METHODS Participants were registered nurses currently working in a general practice setting in Australia, who participated in one-off interviews over Zoom. Interviews were recorded and a thematic analysis was conducted. RESULTS Fourteen nurses participated of which 13 (93%) were female. Three themes were evident in the data: 1) Nurses' current practices in supporting people to quit smoking, 2) The influence of the general practice setting on smoking cessation discussions and 3) The challenges experienced by nurses in providing optimal smoking cessation care. Theme one describes the strategies currently employed by nurses to deliver smoking cessation care such as identifying appropriate clinical scenarios to have smoking cessation conversations with patients. Theme two explores the impact of diversity in the systems, processes, and structures across Australian general practice settings on the support offered by nurses, such as opportunities for ongoing relationships with patients Theme three focuses on ambiguity in nurses' roles within the practice setting including a lack of clarity for nurses in their roles in delivering smoking cessation care in the general practice setting. CONCLUSIONS General practice nurses recognise the importance of their role in providing smoking cessation care and consider that general practice settings are ideally positioned to deliver that care. Smoking cessation care provided by nurses varies according to systems and processes within general practice clinics and relationships with general practitioners. Vaping is an emerging issue and nurses are seeking information on how to address this with patients. There is opportunity to support nurses to provide improved smoking cessation care.
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Affiliation(s)
- Hannah Jongebloed
- Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Australia
| | - Eileen Cole
- Quit Victoria, Cancer Council Victoria, East Melbourne, Australia
| | - Emma Dean
- Quit Victoria, Cancer Council Victoria, East Melbourne, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Australia
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Campopiano von Klimo M, Nolan L, Corbin M, Farinelli L, Pytell JD, Simon C, Weiss ST, Compton WM. Physician Reluctance to Intervene in Addiction: A Systematic Review. JAMA Netw Open 2024; 7:e2420837. [PMID: 39018077 PMCID: PMC11255913 DOI: 10.1001/jamanetworkopen.2024.20837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/07/2024] [Indexed: 07/18/2024] Open
Abstract
Importance The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low. Objective To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions. Data Sources A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021. Study Selection Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included. Data Extraction and Synthesis Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons. Main Outcomes and Measures The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria. Results A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug. Conclusions and Relevance In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.
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Affiliation(s)
| | - Laura Nolan
- JBS International, Inc, North Bethesda, Maryland
| | - Michelle Corbin
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Lisa Farinelli
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jarratt D. Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Caty Simon
- National Survivors Union, Greensboro, North Carolina
- NC Survivors Union, Greensboro, North Carolina
- Whose Corner Is It Anyway, Holyoke, Massachusetts
| | - Stephanie T. Weiss
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Shin SR, Lee EH. Effects of a Smoking Cessation Counseling Education Program on Nursing Students. Healthcare (Basel) 2023; 11:2734. [PMID: 37893808 PMCID: PMC10606355 DOI: 10.3390/healthcare11202734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
This is a quasi-experimental study applying a nonequivalent control group pre-test-post-test design with the control of exogenous variables to compare the research variables among experimental groups. Participants totaled 67 and were divided into three groups, each participating in a different training program (lecture, online video, and case-based peer role-play). There were significant increases in attitudes toward smoking cessation interventions in Experiment 2 (online video) (t = -2.48, p = .021) and Experiment 3 (case-based peer role-play) (t = -2.69. p = .013), efficacy of smoking cessation interventions in Experiment 2 (-2.06, p = .052), and intention to deliver smoking cessation intervention in all experimental groups (Exp 1 t = -5.54, p < .001; Exp 2 t = -2.83, p = .010; Exp 3 t = -3.50, p = .002). All three programs of smoking cessation counseling education (lecture, online video, and case-based peer role-play) used in this study showed meaningful results on the study variables. In conclusion, all of the approaches of this study were found to be effective on the intention to deliver smoking cessation intervention, and it is important to creatively apply counseling programs that include essential elements of smoking cessation interventions in nursing education settings.
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Affiliation(s)
| | - Eun-Hye Lee
- Nursing Department, College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea;
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Dannapfel P, Bendtsen P, Bendtsen M, Thomas K. Implementing smoking cessation in routine primary care-a qualitative study. FRONTIERS IN HEALTH SERVICES 2023; 3:1201447. [PMID: 37899768 PMCID: PMC10613108 DOI: 10.3389/frhs.2023.1201447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023]
Abstract
Background The use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice. Objectives To explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work. Methods A qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers. Results Informants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools. Conclusions Implementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.
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Affiliation(s)
- Petra Dannapfel
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Unit for Change Management and Support, Region Östergötland, Linköping, Sweden
| | - Preben Bendtsen
- Unit for Change Management and Support, Region Östergötland, Linköping, Sweden
- Department of Medical Specialists, Region Östergötland, Motala, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Mersha AG, Eftekhari P, Kennedy M, Gould GS. Attitudes and practices of health care providers towards improving adherence to smoking cessation medications in Australia: A descriptive study. Health Promot J Austr 2023; 34:848-855. [PMID: 36284364 PMCID: PMC10947351 DOI: 10.1002/hpja.674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/08/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Adherence to smoking cessation medications is low and predicts the success of quit attempts. Health care providers (HCPs) role in delivering smoking cessation support is crucial. HCPs support to improve adherence to smoking cessation medication has not been evaluated in Australia. This study describes the attitudes and practices of HCPs in Australia towards adherence to smoking cessation medications (nicotine replacement therapies, varenicline and bupropion) and intervention options. METHODS A descriptive cross-sectional study was conducted using a convenience sample of 70 HCPs in Australia. Participants were recruited through the social media platforms of professional societies in Australia. Data was collected in the periods between November 2020 and September 2021. Descriptive statistics were performed using SPSS statistical software version 27.0 and data was presented using proportions and percentages. RESULTS The majority of participants were doctors, nurses and midwives (82.8%). Almost two-thirds of the participants (68.6%) self-reported that they provided adequate adherence support to individuals taking smoking cessation medications. The majority of participants (87.1%) identified adherence support service as part of their professional role. Only 11.1% of the participants who did not believe supporting medication adherence to be their role reported providing adherence support. The main perceived barriers to adherence support are lack of skill, knowledge, time and resources. HCPs believed that providing additional counselling and monitoring of adherence can improve adherence rates. CONCLUSIONS In an online survey conducted in Australia, HCPs indicated multiple barriers to providing adherence support and intervention strategies that should be considered for smoking cessation programs. A higher proportion of participants who perceived adherence support as their professional role reported supporting adherence to smoking cessation medications. SO WHAT?: Considerations should be given to improve HCPs attitudes and practices towards smoking cessation medications adherence support. Smoking cessation programs should consider the issue of adherence support. Further studies with a larger sample size across a broader range of HCPs are needed to extensively understand adherence service provision among HCPs in Australia.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public HealthThe University of NewcastleNewcastleNSWAustralia
| | - Parivash Eftekhari
- School of Medicine and Public HealthThe University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Michelle Kennedy
- School of Medicine and Public HealthThe University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
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Chan HL, Chan AKY, Chu CH, Tsang YC. Smoking cessation in dental setting: a narrative review on dental professionals' attitude, preparedness, practices and barriers. FRONTIERS IN ORAL HEALTH 2023; 4:1266467. [PMID: 37808607 PMCID: PMC10552527 DOI: 10.3389/froh.2023.1266467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Integration of smoking cessation program into routine oral health care has been advocated by World Health Organization since it brings extensive benefits to oral health. By tobacco cessation, patients are less prone to progression of periodontal disease, have less future tooth loss, have reduced risks of oral mucosal lesions and head and neck cancers. Evidence indicates that dentists are in a favorable position to deliver effective smoking cessation advice to improve patients' oral health. This article aims to present the current situation of smoking cessation in dental setting, including dental management of smoking patients, perceptions of dentists and dental students towards smoking cessation, challenges dental professionals face when carrying out cessation interventions. Patients' perspectives are also evaluated to provide a clearer picture of smoking cessation practice in the dental field. Review of past surveys show most patients welcome smoking cessation advice from dental practitioners. Meanwhile dentists may have wrong assumption that patients would disapprove them if they advise patient to quit smoking. On top of that, main obstacles identified are lack of training, inadequate treatment time and insufficient knowledge towards smoking cessation guidelines and referral routes. With regard to the potential barriers, evidence demonstrates that more trainings on smoking cessation strategies are needed. Future research in this aspect is also indicated to further foster the practice of smoking cessation counselling in dental setting.
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Affiliation(s)
| | | | | | - Y. C. Tsang
- Faculty of Dentistry, The University of Hong Kong, The Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong SAR, China
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van Westen-Lagerweij NA, Willemsen MC, Croes EA, Chavannes NH, Meijer E. The delivery of Ask-Advise-Connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: results of a pre-post implementation study. BMC Health Serv Res 2023; 23:654. [PMID: 37337250 DOI: 10.1186/s12913-023-09692-1] [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: 12/20/2022] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The Ask-Advise-Connect approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The approach has not yet been implemented in general practice in the Netherlands. The aim of this study was to investigate the influence of a comprehensive implementation strategy on the delivery of Ask-Advise-Connect for smoking cessation within Dutch general practice during the COVID-19 pandemic. METHODS A pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers (GPs, practice nurses and doctor's assistants). Participation lasted nine months: during the first three months participants delivered smoking cessation care as usual (pre-intervention); the implementation strategy came into effect after three months and participants were followed up for another six months (post-intervention). The implementation strategy consisted of two meetings in which participants were educated about Ask-Advise-Connect, made agreements on the implementation of Ask-Advise-Connect and reflected on these agreements. Participants also received online educational materials and a desk card as reminder. The changes in the proportions of 'Ask' and 'Advise' over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling. RESULTS Participants provided consultations to 29,112 patients (both smokers and non-smokers). Results of the linear mixed effects model show that the proportion of patients that were asked about smoking ('Ask') significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit smoking ('Advise'). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling post-intervention ('Connect'). CONCLUSIONS The findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice and proactive referral.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands.
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Sustained Effects of a Systems-Based Strategy for Tobacco Cessation Assistance. Am J Prev Med 2023; 64:428-432. [PMID: 36376144 DOI: 10.1016/j.amepre.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Primary care settings that serve lower-income patients are critical for reducing tobacco-related disparities; however, tobacco-related care in these settings remains low. This study examined whether processes for the provision of tobacco cessation care are sustained 18 and 24 months after implementing a health system-level intervention consisting of electronic health record functionality changes and expansion of rooming staff roles. METHODS This nonrandomized stepped-wedge study included electronic health record data from adults with ≥1 primary care visit to 1 of 8 community-based clinics between August 2016 and September 2019. Generalized estimating equations methods were used to compute ORs of asking about tobacco use and among those who use tobacco, providing brief advice to quit and assessing readiness to quit, contrasting 18 and 24 months after implementation to both preimplementation (baseline) and 12 months after implementation. Using a 2-level model of patients clustered in clinics, outcomes were examined over time by clinic site. Analyses were conducted in 2022. RESULTS A total of 305,665 patient visits were evaluated. Significantly higher odds of all 3 outcomes were observed at 18 and 24 months than at baseline. The odds of asking about tobacco use increased, whereas the odds of advising to quit were similar at 18 and 24 months to those at 12 months. Odds of assessing readiness to quit decreased at 18 months (OR=0.71; 95% CI=0.63, 0.80) and 24 months (OR=0.46; 95% CI=0.40, 0.52). Performance varied significantly by clinical site. CONCLUSIONS Health system changes can have a sustained impact on tobacco assessment and the provision of brief advice among lower-income patients. Strategies to sustain assessment of readiness to quit are warranted.
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Mahoto SK, Mitonga HK, Oladimeji O. Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia. J Public Health Afr 2023; 14:1992. [PMID: 37065816 PMCID: PMC10099956 DOI: 10.4081/jphia.2023.1992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/25/2022] [Indexed: 03/06/2023] Open
Abstract
Background. Healthcare workers (HCWs) can play a signifi- cant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke.
Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia.
Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated.
Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs- based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) sys- tem-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC.
Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the deliv- ery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.
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Bhatt G, Goel S, Grover S, Medhi B, Jaswal N, Gill SS, Singh G. Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State. PLoS One 2023; 18:e0284920. [PMID: 37141319 PMCID: PMC10159160 DOI: 10.1371/journal.pone.0284920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation. METHODS A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes. RESULTS The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives). CONCLUSION The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Jaswal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Singh Gill
- Department of Health & Family Welfare, Government of Punjab, National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke, Chandigarh, India
| | - Gurmandeep Singh
- Department of Health & Family Welfare, Government of Punjab, National Health Mission, Chandigarh, India
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Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Lang AE, MacMurdo M, Upson D. Increasing Access to Treatment for Nicotine Dependence. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Dotlic J, Markovic N, Gazibara T. Patterns of smoking and menopause-specific quality of life: smoking duration matters more. Behav Med 2023; 49:29-39. [PMID: 34818993 DOI: 10.1080/08964289.2021.1958739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck's Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women.Supplemental data for this article is available online at.
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Affiliation(s)
- Jelena Dotlic
- Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Tatjana Gazibara
- Institute for Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Documentation of smoking in scheduled asthma contacts in primary health care: a 12-year follow-up study. NPJ Prim Care Respir Med 2022; 32:44. [PMID: 36271085 PMCID: PMC9587006 DOI: 10.1038/s41533-022-00309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Smoking among asthmatics is common and associates with poorer asthma control, more rapid lung function decline and higher health care costs in dose-dependent manner. No previous real-life studies exist, however, on how smoking status and pack-years are documented in scheduled asthma contacts in primary health care (PHC) during long-term follow-up, and how often patients are advised to quit smoking. In this real-life 12-year follow-up study, we showed that out of all scheduled PHC asthma contacts (n = 603) smoking was mentioned only in 17.2% and pack-years only in 6.5%. Smoking data was not recorded even once in 70.9% of never smokers, 64.7% of ex-smokers and 27.3% of current smokers. Smoking including pack-years were mentioned more often if nurse took part on the scheduled contact. For current smokers, smoking cessation was recommended only in 21.7% of their scheduled contacts. Current smokers used more antibiotics and had more unscheduled health care contacts during follow-up.
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Affiliation(s)
- Jaana Takala
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. .,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. .,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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15
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Meijer E, Gebhardt WA, van Laar C, Chavannes NH, van den Putte B. Identified or conflicted: a latent class and regression tree analysis explaining how identity constructs cluster within smokers. BMC Psychol 2022; 10:231. [PMID: 36207742 PMCID: PMC9547436 DOI: 10.1186/s40359-022-00937-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Identity, or ‘who I am’, is important for smoking behaviour. Identity constructs (parts of a person’s identity) are typically examined as separate entities, but emerging evidence suggests that the multifaceted nature of identity is relevant in the context of smoking. This cross-sectional study examined how smoking-related self- and group-identity constructs cluster within adult daily smokers (N = 231), whether classes of smokers can be distinguished based on clusters of identity constructs, and which factors explain class membership. Data were collected online in The Netherlands and Belgium, 2017–2018. Latent class and regression tree analyses showed that participants in Class 1 of ‘Identified smokers’ (estimated population share 54%) reported stronger smoker self- and group-identities, stronger expected identity loss when quitting smoking, and weaker quitter self-identities and non-smoker self- and group-identities (vs. Class 2 of ‘Conflicted smokers’). Class membership was explained by the interaction between mental smoking dependence (dominant explanatory variable), consideration of future consequences, age of smoking onset, self-efficacy, and future self thought clarity. Models had good fit. The identity of more dependent smokers is more strongly oriented toward smoking. Smoking is also more strongly embedded in the identity of smokers who started smoking young, are less inclined to think about the future, and have lower self-efficacy.
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Affiliation(s)
- E Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. .,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands.
| | - W A Gebhardt
- Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - C van Laar
- Social and Cultural Psychology, University of Leuven, Leuven, Belgium
| | - N H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - B van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
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16
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Darville A, Williams L, Edward J, Butler K, Rademacher K, Gray B, Tischner CM, Keeler H, Hahn EJ. Enhancing Tobacco Treatment for Medicaid Recipients. South Med J 2022; 115:603-610. [PMID: 35922046 DOI: 10.14423/smj.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients. METHODS Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations. RESULTS Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities. CONCLUSIONS The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.
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Affiliation(s)
- Audrey Darville
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Lovoria Williams
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Jean Edward
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Karen Butler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Kathy Rademacher
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Brittney Gray
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Clair M Tischner
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Hannah Keeler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Ellen J Hahn
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
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17
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An online survey on knowledge, attitude and practice among primary healthcare providers towards smoking cessation in Selangor, Malaysia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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de Frel DL, Janssen VR, Meijer E, Atsma DE. Optimizing Smoking Cessation Counseling in a University Hospital: Results and Pitfalls. FRONTIERS IN HEALTH SERVICES 2022; 2:882964. [PMID: 36925867 PMCID: PMC10012747 DOI: 10.3389/frhs.2022.882964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022]
Abstract
Background Healthcare professionals (HPs) can play a substantial role in smoking cessation counseling (SCC) but in practice often skip this task due to time constraints. This study evaluates the implementation of the rapid Ask-Advise-Connect (AAC) method in a University hospital setting. Methods This mixed methods pre-post interventional study was performed at the Cardiology department of a University hospital and consisted of (1) a quantitative assessment of patient smoking registration and HP connection rates to external SCC from the Electronic Medical Record, (2) semi-structured interviews with 10 HPs to assess their attitudes toward AAC, and (3) a blended intervention aimed to implement AAC. The blended intervention consisted of face-to-face and online AAC psychoeducation for HPs followed-up with motivational messages on their smart pagers over a period of 6 weeks. Results In total, 48,321 patient registrations and 67 HPs were included. Before AAC implementation, HPs assessed smoking status in 74.0% of patients and connected 9.3% of identified smokers with SCC. Post intervention, these percentages did not increase (73.2%, p = 0.20; and 10.9%, p = 0.18, respectively). Nonetheless, the vast majority (90%) of HPs feel it is important to discuss patient smoking, and view it as their duty to do so. Main barriers to AAC reported by HPs were forgetfulness and time pressure. Conclusion This study shows that this AAC intervention does not increase Asking after smoking status or Connection of patients to SCC in a University Hospital. However, HPs hold positive attitudes toward AAC. A better understanding of the mechanisms required for optimizing HPs practice behavior is needed.
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Affiliation(s)
- Daan L de Frel
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Association Arts en Leefstijl (Physician and Lifestyle), Utrecht, Netherlands
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19
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Rahman AU, Mambali M, Keshavarzi F, Baig MI, Hariadha E, Farrukh M. Evaluation of smoking prevalence, secondhand smoke exposure, attitudes of tobacco control, and smoking cessation knowledge among pharmacy and medical students in a private university, Malaysia. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:38-45. [PMID: 35784108 PMCID: PMC9245913 DOI: 10.4103/jpbs.jpbs_334_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Tobacco use is one of the leading causes of premature morbidity and mortality globally, causing over eight million deaths per year. One of the best approaches to reduce smoking-related deaths is to encourage future health-care professionals in tobacco control programs. Objectives: To assess the smoking prevalence, secondhand smoke exposure, attitudes toward tobacco control, and smoking cessation knowledge and associated factors among pharmacy and medical students in a private university in Malaysia. Methodology: A cross-sectional study was conducted at two campuses of a private University in Malaysia, and the data were collected online using the Global Health Professionals Students Survey questionnaire and analyzed using IBM-SPSS Version 20. Results: The overall smoking prevalence was 1.6% (P = 0.009). The exposure to secondhand smoke was 21% and 39% at home and in public places, respectively. About 92% of respondents had a good attitude toward tobacco control, whereas 53.4% had good smoking cessation knowledge. However, only 39.4% of the respondents had received formal smoking cessation training. Logistic regression revealed that significant predictors toward tobacco control are the ban of tobacco sales to adolescents, ban on the advertising of tobacco products, ban of smoking in restaurants, and obtaining a specific training on cessation techniques. Conclusions: The prevalence of smoking among pharmacy and medical students was low, but exposure to secondhand smoke was higher. Most of the respondents had a positive attitude and good knowledge of smoking cessation. However, future training needs to be conducted among upcoming health-care professionals to act as a role model for community transformation.
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20
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Economou MA, Kaiser BN, Yoeun SW, Crable EL, McMenamin SB. Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221096289. [PMID: 37091072 PMCID: PMC9924244 DOI: 10.1177/26334895221096289] [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] [Indexed: 11/16/2022] Open
Abstract
Background In 2016, the California Department of Healthcare Services (DHCS) released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. Methods We assessed fidelity through semi-structured interviews with MCP health educators (N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. Results The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers' identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. Conclusions The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. Plan Language Summary In 2016, the California Department of Healthcare Services (DHCS) in California released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.
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Affiliation(s)
- Melina A. Economou
- Department of Anthropology, University of California, San Diego, CA,
USA
| | - Bonnie N. Kaiser
- Department of Anthropology, University of California, San Diego, CA,
USA
- Global Health Program, University of California, San Diego, CA,
USA
- UC San Diego ACTRI Dissemination and
Implementation Science Center, San Diego, CA, USA
| | - Sara W. Yoeun
- Herbert Wertheim School of Public Health, University of California,
San Diego, CA, USA
| | - Erika L. Crable
- UC San Diego ACTRI Dissemination and
Implementation Science Center, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA,
USA
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health, University of California,
San Diego, CA, USA
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21
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Hirvonen E, Karlsson A, Saaresranta T, Laitinen T. Documentation of the patient's smoking status in common chronic diseases - analysis of medical narrative reports using the ULMFiT based text classification. Eur Clin Respir J 2021; 8:2004664. [PMID: 34868489 PMCID: PMC8635564 DOI: 10.1080/20018525.2021.2004664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Smoking cessation is essential part of a successful treatment in many chronic diseases. Our aim was to analyse how actively clinicians discuss and document patients' smoking status into electronic health records (EHR) and deliver smoking cessation assistance. METHODS We analysed the results using a combination of rule and deep learning-based algorithms. Narrative reports of all adult patients, whose treatment started between years 2010 and 2016 for one of seven common chronic diseases, were followed for two years. Smoking related sentences were first extracted with a rule-based algorithm. Subsequently, pre-trained ULMFiT-based algorithm classified each patient's smoking status as a current smoker, ex-smoker, or never smoker. A rule-based algorithm was then again used to analyse the physician-patient discussions on smoking cessation among current smokers. RESULTS A total of 35,650 patients were studied. Of all patients, 60% were found to have a smoking status in EHR and the documentation improved over time. Smoking status was documented more actively among COPD (86%) and sleep apnoea (83%) patients compared to patients with asthma, type 1&2 diabetes, cerebral infarction and ischemic heart disease (range 44-61%). Of the current smokers (N=7,105), 49% had discussed smoking cessation with their physician. The performance of ULMFiT-based classifier was good with F-scores 79-92. CONCLUSION Ee found that smoking status was documented in 60% of patients with chronic disease and that the clinician had discussed smoking cessation in 49% of patients who were current smokers. ULMFiT-based classifier showed good/excellent performance and allowed us to efficiently study a large number of patients' medical narratives.
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Affiliation(s)
- Eveliina Hirvonen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of TurkuTurkuFinland
| | - Antti Karlsson
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of TurkuTurkuFinland
| | - Tarja Laitinen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Administration Centre, Tampere University Hospital, Tampere, Finland
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22
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Mersha AG, Kennedy M, Eftekhari P, Gould GS. Predictors of Adherence to Smoking Cessation Medications among Current and Ex-Smokers in Australia: Findings from a National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212225. [PMID: 34831981 PMCID: PMC8619677 DOI: 10.3390/ijerph182212225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022]
Abstract
Background: Adherence to smoking cessation medications (SCMs) improve the rate of successful quitting. This study aimed to evaluate the level of adherence to SCMs and associated factors among smokers and ex-smokers in Australia. Method: A cross-sectional study using an online survey was conducted in Australia. Descriptive statistics were used to present the overall characteristics of participants. Cross-tabulation with Pearson’s chi-square test was performed to evaluate the possible associations between factors. To explore barriers and facilitators of adherence to SCMs, logistic regressions were conducted. Results: Among 201 participants, 57 (28.4%) were found to be adherent to SCMs. The odds of being adherent were found to be higher among participants with good social support (AOR = 3.28, 95% CI of 2.30–6.27). Participants who did not experience anxiety symptoms had higher odds of being adherent to SCMs as compared to smokers who had anxiety symptoms (AOR = 4.41, 95% CI of 3.64–14.68). Having previous experience of using SCMs improved adherence four-fold (AOR = 3.87, 95% CI of 1.11–13.44). Level of nicotine dependence showed a direct association with adherence (AOR = 3.53, 95% CI of 1.40–8.95). Not relapsing while on the medications improved adherence (AOR = 2.88, 95% CI of 1.21–6.88). Conclusion: In a study of smokers and ex-smokers in Australia, the self-reported level of adherence to SCMs was found to be low. Adherence was associated with social, psychological, and medication-related factors. Smoking cessation interventions are recommended to include strategies that can address medication adherence.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Correspondence:
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
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23
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Meijer E, Korst JS, Oosting KG, Heemskerk E, Hermsen S, Willemsen MC, van den Putte B, Chavannes NH, Brown J. "At least someone thinks I'm doing well": a real-world evaluation of the quit-smoking app StopCoach for lower socio-economic status smokers. Addict Sci Clin Pract 2021; 16:48. [PMID: 34321088 PMCID: PMC8320182 DOI: 10.1186/s13722-021-00255-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking is more prevalent and persistent among lower socio-economic status (SES) compared with higher-SES groups, and contributes greatly to SES-based health inequities. Few interventions exist that effectively help lower-SES smokers quit. This study evaluated "De StopCoach", a mobile phone delivered eHealth intervention targeted at lower-SES smokers based on the evidence-based StopAdvisor, in a real-world setting (five municipalities) in The Netherlands in 2019-2020. METHOD We conducted individual semi-structured interviews with project leaders, healthcare professionals, and participating smokers (N = 22), and examined log data from the app (N = 235). For practical reasons, SES of app users was not measured. Qualitative data were analysed using the Framework Approach, with the Consolidated Framework for Implementation Research (CFIR) and Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical models. RESULTS Qualitative data showed that factors from the Intervention and Setting domains were most important for the implementation. StopCoach seemed suitable for lower-SES smokers in terms of performance and effort expectancy, especially when integrated with regular smoking cessation counseling (SCC). Key barriers to implementation of the app were limited integration of the app in SCC programs in practice, difficulty experienced by project leaders and healthcare professionals to engage the local community, and barriers to SCC more generally (e.g., perceived resistance to quitting in patients) that prevented healthcare professionals from offering the app to smokers. Quantitative data showed that 48% of app users continued using the app after the preparation phase and pre-quit day, and that 33% of app users had attempted to quit. Both app adherence and quit attempts were more likely if smokers also received SCC from a professional coach. Posthoc analyses suggest that adherence is related to higher likelihood of a quit attempt among participants with and without a professional coach. CONCLUSIONS Smokers, healthcare professionals and project leaders indicated in the interviews that the StopCoach app would work best when combined with SCC. It also appears from app log that app adherence and quit attempts by app users can be facilitated by combining the app with face-to-face SCC. As such, blended care appears promising for helping individual smokers quit, as it combines the best of regular SCC and eHealth. Further research on blended care for lower-SES smokers is needed.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke S. Korst
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Kristiene G. Oosting
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Heemskerk
- Pharos Dutch Center of Expertise On Health Disparities, Utrecht, The Netherlands
| | - Sander Hermsen
- OnePlanet Research Center, Imec NL, Wageningen, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Collaboration, London, UK
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24
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Smoking among adult congenital heart disease survivors in the United States: Prevalence and relationship with illness perceptions. J Behav Med 2021; 44:772-783. [PMID: 34185220 DOI: 10.1007/s10865-021-00239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
The relationship between smoking and illness perceptions among congenital heart disease (CHD) survivors is unknown. The primary aims of the present study were to compare the smoking prevalence among CHD survivors to a nationally representative U.S. sample and examine the relationship between smoking and illness perceptions. CHD survivors (N = 744) from six U.S. sites participated in the study. The smoking prevalence among CHD survivors (9.3%) was lower than the general population (15.3%). However, 23.3% of CHD survivors with severe functional limitations smoked. Smoking prevalence differed by U.S. region, with a greater proportion of those attending CHD care in the Midwest reporting smoking (11.8%). The illness perception dimensions of Concern and Emotional Response were independently associated with smoking. Differences in illness perceptions enhance our understanding of smoking among CHD survivors and may guide interventions promoting positive health behaviors. The protocol for the study from which the present analyses were conducted was recorded at ClinicalTrials.gov: NCT02150603.
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25
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van Westen-Lagerweij NA, Meeuwsen EG, Croes EA, Meijer E, Chavannes NH, Willemsen MC. The referral of patients to smoking cessation counselling: perceptions and experiences of healthcare providers in general practice. BMC Health Serv Res 2021; 21:583. [PMID: 34140004 PMCID: PMC8210508 DOI: 10.1186/s12913-021-06618-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few European smokers receive professional counselling when attempting to quit smoking, resulting in suboptimal success rates and poor health outcomes. Healthcare providers in general practice play an important role in referring smokers to smoking cessation counselling. We chose the Netherlands as a case study to qualitatively explore which factors play a role among healthcare providers in general practice with regard to referral for smoking cessation counselling organised both inside and outside general practice. Methods We conducted four focus groups and 18 telephone interviews, with a total of 31 healthcare providers who work in general practice. Qualitative content analysis was used to identify relevant factors related to referral behaviours, and each factor was linked to one of the three main components of the COM-B behaviour model (i.e., capability, opportunity and motivation) as well as the six sub-components of the model. Results Dutch healthcare providers in general practice typically refer smokers who want to quit to counselling inside their own general practice without actively discussing other counselling options, indicating a lack of shared decision making. The analysis showed that factors linked to the COM-B main components ‘capability’ and ‘opportunity’, such as healthcare providers’ skills and patients’ preferences, play a role in whether patients are referred to counselling inside general practice. Factors linked to all three COM-B components were found to play a role in referrals to counselling outside general practice. These included (knowledge of) the availability and quality of counselling in the region, patients’ requests, reimbursement, and sense of urgency to refer. The identified factors can both act as barriers and facilitators. Conclusions The findings of this research suggest that more smokers can be reached with smoking cessation counselling if implementation interventions focus on: (i) equipping healthcare providers with the knowledge and skills needed to refer patients; (ii) creating more opportunities for healthcare providers to refer patients (e.g., by improving the availability and reimbursement of counselling options); and (iii) motivating healthcare providers to discuss different counselling options with patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06618-7.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands. .,Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Elisabeth G Meeuwsen
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Khanna N, Klyushnenkova E, Rao V, Siegel N, Wolfe S. Electronic referrals to the tobacco Quitline: implementation strategies in a large health system to optimize delivery of tobacco cessation to patients. Transl Behav Med 2021; 11:1107-1114. [PMID: 33410484 DOI: 10.1093/tbm/ibaa094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Electronic referrals provide an efficient solution for clinicians to connect patients to free tobacco cessation services, such as the tobacco Quitline. However, strategic planning is necessary for the successful adoption of this method across the health care system. The purpose of this study was to develop an implementation strategy for electronic referrals to the tobacco Quitline in a large health system. A clinical decision support tool created a closed-loop e-referral pathway between the electronic health record system and the Quitline. Multilevel strategies were developed to implement the e-referral process across the entire health system, including leadership buy-in, Epic tip sheets, newsletters, training for practice champions and staff, physician educator, patient-focused advertisements, and video clips distribution by the Maryland Department of Health Center for Tobacco Prevention and Control. The implementation of a system-wide e-referral pathway for tobacco cessation involved continuous clinician education and training, systematic quality control, and engaging "champion" clinicians. Postimplementation data analysis revealed that 1,790 e-referrals were received by the Quitline in 2018-2019, of which 18% accepted follow-up services, 18% declined, and 64% were not reached after multiple attempts. Among 322 patients who accepted Quitline services, 55% requested nicotine replacement therapy. Overall, 282 clinicians referred patients, including 107 primary care physicians and 175 specialists; 62 clinicians e-referred 72% patients, thereby emerging as "tobacco champions." The e-referral process is an efficient method for tobacco users to receive a cessation referral from clinicians. Sustainability can be achieved through leadership buy-in, physician ease of use, patient motivation, information technology supports, and reminders.
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Affiliation(s)
- Niharika Khanna
- Department of Family and Community Medicine, Section on Population Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elena Klyushnenkova
- Department of Family and Community Medicine, Section on Population Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vibha Rao
- Department of Family and Community Medicine, Section on Population Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Neil Siegel
- Department of Family and Community Medicine, Section on Population Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sara Wolfe
- Center for Tobacco Prevention and Control, Maryland Department of Health, Baltimore, MD, USA
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Huang WC, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Freeman B, Jan S, Negin J, Marks GB, Fox GJ. Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam. BMC Public Health 2021; 21:845. [PMID: 33933063 PMCID: PMC8088640 DOI: 10.1186/s12889-021-10880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam. Methods We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit. Results Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national/provincial hospitals (30.3%) than those visiting district hospitals (11.3%, p < 0.001) and commune health centres (11.1%, p = 0.004). Conclusions Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10880-z.
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Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam. .,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. .,Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Meijer E, Chavannes NH. Lacking willpower? A latent class analysis of healthcare providers' perceptions of smokers' responsibility for smoking. PATIENT EDUCATION AND COUNSELING 2021; 104:620-626. [PMID: 32943247 DOI: 10.1016/j.pec.2020.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/29/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Healthcare providers' (HCPs) perceptions of smokers' responsibility for smoking may affect implementation of smoking cessation care (SCC), but are understudied. This study examined Dutch HCPs' perceptions of smokers' responsibility for smoking, and how many and which subgroups exist with regard to these perceptions. METHODS Observational cross-sectional study among physicians and other HCPs (N = 570). Latent class analysis was used to analyse data. RESULTS Results showed two latent classes of HCPs: a majority (77 %) that appeared to hold smokers themselves more accountable for their smoking, and a minority (23 %) that seemed more inclined to believe that people smoked as a consequence of factors such as addiction, and smoking initiation when people were young and could not foresee consequences. The two-class model showed excellent certainty in classification. Class membership was associated with age, working experience, and smoking status. The majority class experienced more barriers to SCC than the minority class and provided SCC tasks to fewer patients. CONCLUSIONS HCPs' perceptions of smokers' responsibility for smoking relate to HCP background characteristics, barriers to SCC and implementation of SCC. PRACTICE IMPLICATIONS New approaches to improving SCC might be needed that take HCP's perceptions of smokers' responsibility into account.
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Affiliation(s)
- E Meijer
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - N H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Harutyunyan A, Abrahamyan A, Grigoryan Z, Hayrumyan V, Truzyan N, Petrosyan V. Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study. Tob Prev Cessat 2020; 6:70. [PMID: 33409424 PMCID: PMC7762926 DOI: 10.18332/tpc/130475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Smoking cessation interventions within tuberculosis (TB) care are feasible, effective and efficient for increasing smoking cessation rates. We aimed to assess TB physicians’ smoking cessation knowledge, attitude, and practices (KAP). METHODS We conducted a qualitative study with 21 TB physicians and utilized directed deductive content analysis with predefined knowledge, attitude, and practice categories. Physicians’ practice was analyzed using the ABC approach (Ask, Brief advice, and Cessation support). RESULTS Physicians acknowledged the importance of quitting for improved treatment outcomes and decreased risk of TB relapse. Physicians revealed presumed drug interactions, possible side effects of pharmacotherapy, and reluctance to take additional medications as challenges of smoking cessation interventions. Physicians asked about smoking behavior and provided a brief quitting advice to TB patients; however, implementation of cessation support was limited due to poor knowledge of evidence-based cessation methods and the absence of formal tobacco dependence treatment algorithms within TB care. CONCLUSIONS TB physicians’ KAP on smoking cessation was limited. Interventions targeting physicians’ knowledge and skills, and formalization of tobacco dependence treatment within TB care, are core for improving their smoking cessation practices in Armenia.
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Affiliation(s)
- Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Armine Abrahamyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Zaruhi Grigoryan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Nune Truzyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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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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Põld M, Pärna K. Changes in Addressing Patients' Smoking: Cross-Sectional Data from 2002 and 2014 among Physicians in Estonia. Tob Use Insights 2020; 13:1179173X20949269. [PMID: 32922108 PMCID: PMC7446266 DOI: 10.1177/1179173x20949269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background: For health professionals, personal and contextual factors influence addressing patients’ smoking habits. The objective of the study was to describe frequency of addressing patients’ smoking in 2002 and 2014 and to analyse factors related to addressing patients’ smoking habits. Methods: Data of physicians from 2 postal cross-sectional surveys were used (n = 4140 in 2002, n = 5666 in 2014). The number of respondents was 2747 in 2002 and 2903 in 2014. The corrected response rate was 67.8% and 53.1%, respectively. Age-standardized frequency of addressing patients’ smoking during the last 7 days was determined. Distribution of other variables along with confidence intervals (CI) was calculated. Logistic regression was used to analyse association of addressing patients’ smoking with attitudes and perceived barriers regarding addressing patients’ smoking and with background factors. Fully adjusted odds ratios (OR) with 95% CIs were calculated. Results: The age-standardized prevalence of addressing patients’ smoking habits among men was 84.4% (95% CI 80.3–88.5) in 2002 and 88.3% (95% CI (84.5–92.2) in 2014, among women 82.1% (95% CI 80.2–83.9) and 89.0% (95% CI 87.2–90.8), respectively. According to logistic regression analysis, in 2014, significantly more physicians agreed that it is doctors’ responsibility to convince people to stop smoking (among men, OR 2.32; 95% CI 1.19–4.54, among women OR 1.41; 95% CI 1.06–1.88), that smoking prevention should form part of health professionals’ training, that physicians should have smoking related hand-out materials, and that lack of time was a barrier to addressing patients’ smoking. Addressing patients’ smoking was significantly associated with attitudes and perceived barriers regarding addressing patients’ smoking, age, and other background factors (among women only). Conclusions: Addressing patients’ smoking habits was more common in 2014 than in 2002, but the change was significant among women only. Compared to 2002, in 2014 physicians’ attitudes regarding addressing patients’ smoking were more approving. Results of this study are useful for policymakers and institutions involved in organization and development of smoking prevention training and cessation services.
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Affiliation(s)
- Mariliis Põld
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kersti Pärna
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Zhang L, Li J, Lv Y, Yang X, Bai L, Luo Y, Chen Y, Zhao Y. Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students. Tob Induc Dis 2020; 18:65. [PMID: 32818028 PMCID: PMC7425755 DOI: 10.18332/tid/125231] [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: 04/02/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China. METHODS A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model. RESULTS In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05). CONCLUSIONS Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.
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Affiliation(s)
- Li Zhang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Jun Li
- The Office of Chongqing Medical University, Chongqing, China
| | - Yalan Lv
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xia Yang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Li Bai
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
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Meijer E, Chavannes N, Segaar D, Parlevliet J, Van Der Kleij R. Optimizing smoking cessation guideline implementation using text-messages and summary-sheets: A mixed-method evaluation. CLINICAL EHEALTH 2019. [DOI: 10.1016/j.ceh.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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