1
|
Hyndman K, Thomas RE, Schira HR, Bradley J, Chachula K, Patterson SK, Compton SM. The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214158. [PMID: 31661922 PMCID: PMC6862178 DOI: 10.3390/ijerph16214158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 01/18/2023]
Abstract
The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I2 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I2 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I2 = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.
Collapse
Affiliation(s)
- Kathryn Hyndman
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Roger E Thomas
- School of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
| | - H Rainer Schira
- John E. Robbins Library, Brandon University, Manitoba R7A 6A9, Canada.
| | - Jenifer Bradley
- Department of National Defence, Petawawa, Ontario K8H 2X3, Canada.
| | - Kathryn Chachula
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Steven K Patterson
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
| | - Sharon M Compton
- Dental Hygiene Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
| |
Collapse
|
2
|
Buettner-Schmidt K, Maack B, Larson M, Orr M, Miller DR, Mills K. Systems change to improve tobacco use identification and referral in the chiropractic setting: a pilot study. Chiropr Man Therap 2018; 26:45. [PMID: 30534361 PMCID: PMC6260883 DOI: 10.1186/s12998-018-0214-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Tobacco use remains a leading cause of death and disability in the United States. Health professionals need to address the use of tobacco products by their patients, but chiropractic clinical systems often remain unsupported and underappreciated in their role to facilitate tobacco use cessation. Methods This pilot study tested an intervention to assist a chiropractic community to implement sustainable health systems changes for tobacco use based on U.S. Public Health Service guidelines. Chiropractors were educated on the Ask, Advise, Refer (AAR) approach, provided with ongoing guidance, and followed for six months to assess systems change. The study was conducted from March 2016 to July 2017. Results Evidence of a systematic process in place to conduct AAR was present in all clinics by the end of the fourth month of the intervention period. Although no clinic had sustained health system change for full AAR, all six of the clinics made progress in the individual AAR components. Furthermore, five clinics achieved sustained system change for the Ask component, as after systems change was achieved, the rate of tobacco user identifications did not drop below 50%. For the Advise component, five clinics succeeded in having individual months of ≥50% of tobacco users being advised, and three clinics achieved the formal definition of systems change. For the Refer component, no clinic achieved system change, although four had individual months of ≥50% of tobacco users being referred. The patient quit rate was 13.3% (n = 15) for the 30-day follow-up and 16.7% (n = 6) for the three-month follow-up. Conclusions This study demonstrates the feasibility of implementing a health systems change in the chiropractic setting to identify tobacco users, to advise them to quit, and to refer users for cessation services.
Collapse
Affiliation(s)
- Kelly Buettner-Schmidt
- 1College of Health Professions, School of Nursing, North Dakota State University, 1919 University Drive North, D102, Fargo, ND 58102 USA
| | - Brody Maack
- 2College of Health Professions, School of Pharmacy, North Dakota State University, Fargo, ND 58102 USA
| | - Mary Larson
- 3College of Health Professions, Department of Public Health, North Dakota State University, Fargo, ND 58102 USA
| | - Megan Orr
- 4Department of Statistics, North Dakota State University, Fargo, ND 58102 USA
| | - Donald R Miller
- 2College of Health Professions, School of Pharmacy, North Dakota State University, Fargo, ND 58102 USA
| | - Katelyn Mills
- 5Roger Maris Cancer Center, Sanford Health, Fargo, ND 58102 USA
| |
Collapse
|
3
|
Ye L, Goldie C, Sharma T, John S, Bamford M, Smith PM, Selby P, Schultz ASH. Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review. Nicotine Tob Res 2018; 20:531-542. [PMID: 28371888 DOI: 10.1093/ntr/ntx072] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/28/2017] [Indexed: 11/12/2022]
Abstract
Introduction The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. Aims and Methods A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Results Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. Conclusions This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. Implications This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).
Collapse
Affiliation(s)
- Lisa Ye
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Catherine Goldie
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Tanvi Sharma
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Sheila John
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Megan Bamford
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Patricia M Smith
- Human Science Division, Northern Ontario School of Medicine, ON, Canada
| | - Peter Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Asper Clinical Research Institute, Winnipeg, MB, Canada
| |
Collapse
|
4
|
Hawk C, Ramcharan M, Kruger CL. Training chiropractic students in weight management counseling using standardized patients. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 32:23-31. [PMID: 29227718 PMCID: PMC5834297 DOI: 10.7899/jce-17-9r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to describe and assess an activity that trained chiropractic students to counsel patients on weight management through the use of standardized patients. METHODS This was a descriptive study using mixed methods. Students were trained to apply health behavior theory and the transtheoretical model. Standardized patients were given a case to portray with the students. Students had 15 minutes for the encounter. The encounters were assessed in 2 ways: (1) standardized patients answered a brief questionnaire about the students' performance, and (2) students answered a questionnaire about the utility of the intervention. Numerical data were extracted from the audiovisual management platform, and statistics were computed for each question. Comments made by students and patients were transferred verbatim for content analysis. RESULTS A total of 102 students took part in the activity. Students' performance in the encounter was uniformly high, with over 90% "yes" responses to all questions except "gave me printed information material" and "discussed the printed material with me." The key issue identified in the comments by standardized patients was that students tended not to connect weight management with their chief complaint (low back pain). Nearly all students (97%) thought the activity would be useful to their future practice, and 97% felt it had increased their confidence in providing weight management counseling. CONCLUSION This experiential activity was assessed to be useful to students' future practice and appeared to provide them with skills to successfully communicate with patients on weight management.
Collapse
|
5
|
Kaeser MA, Hawk C, Anderson ML, Reinhardt R. Community-based free clinics: opportunities for interprofessional collaboration, health promotion, and complex care management. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:25-9. [PMID: 26241702 PMCID: PMC4770992 DOI: 10.7899/jce-15-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Free or outreach clinics offer students the opportunity to work with diverse patient populations. The objective of this study was to describe the demographics and clinical characteristics of a sample of chiropractic patients at a free community-based clinic to assess clinical and educational opportunities for students to work with diverse populations, collaborate with other professions and practice health promotion through patient education. METHODS This was a prospective, descriptive cross-sectional study conducted over 2 months. Data on demographics, health status, and health risks were collected from patients and their interns. RESULTS Of the 158 patients, 50.6% were women and 50.6% African-American, while only 20.9% were employed full-time. Of the 24.7% tobacco users, 48.7% expressed interest in cessation. Of 80.0% overweight or obese patients, 48.8% expressed interest in weight loss. By self-report, 16.5% were diabetic, 10.1% took hypertension medication, 36.7% used prescription pain medication (9.4% opiate use), 33.5% used nonprescription pain medication, and 9.4% were under the care of a mental health professional. CONCLUSION This patient population is demographically diverse. A high proportion of patients who used tobacco, or were overweight or obese expressed interest in information on those topics. A substantial proportion reported being under care with a mental health professional. This clinic provides opportunities for students to work with diverse populations, collaborate with other professions, and practice health promotion.
Collapse
|
6
|
Hawk C, Evans MW. A framework for chiropractic training in clinical preventive services. Chiropr Man Therap 2013; 21:28. [PMID: 23962353 PMCID: PMC3751788 DOI: 10.1186/2045-709x-21-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/17/2013] [Indexed: 11/30/2022] Open
Abstract
The 2010 Patient Protection and Affordable Care Act provides incentives for both patients and providers to engage in evidence-based clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF). Depending upon the application of the new health care act, Doctors of Chiropractic (DC) may be considered to be covered providers of many of these services. It is therefore essential that DCs’ training prepare them to competently deliver them. The aim of this commentary is to describe a framework for training in clinical preventive services, based largely on the USPSTF recommendations, which could be readily integrated into existing DC educational programs.
Collapse
Affiliation(s)
- Cheryl Hawk
- Logan College of Chiropractic, 1851 Schoettler Rd, 63017 Chesterfield, MO, USA.
| | | |
Collapse
|