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Poster presentation:
Training physicians and pharmacists in smoking cessation counselling: preliminary results
Alexander Prokhorov
Abstract
Project TEAM is community-based intervention study designed to enhance smoking cessation counseling skills among physicians and pharmacists participating in a 3-hr continuing education program with video vignettes and role-playing counseling segments. Clinicians randomized to the control condition participated in a similar-length training program, addressing skin cancer prevention counseling. The study design was a nested group-randomized trial with four treatment conditions, using both cross-sectional and cohort repeated measures with community serving as the unit of randomization. Pharmacists received an adapted version of the well-known Rx for Change© curriculum for pharmacy students (Karen S. Hudmon, co-Principal Author) whereas physicians received the Nicotine Dependence Across the Lifespan© continuing medical education course (Alexander V. Prokhorov, Principal Author) supplemented with elements from the aforementioned curriculum for pharmacy students. A principal goal of the study is to determine whether a tobacco cessation continuing education program for physicians and pharmacists practicing in the same community results in synergistic outcomes with respect to counseling and treatment of their patients in smoking cessation. The study is ongoing; trainings for pharmacists and physicians are complete, and data collection is well underway in our 16 target communities.
In the cross-sectional part (independent sample surveys), health care providers’ counseling practices were assessed by adherence to the 5 A’s model (Ask, Advise, Assess, Assist, and Arrange follow-up) documented during patient exit interviews from physicians’ offices and pharmacies at baseline and at 3 months post-training. Thus far, the baseline survey has been completed by 1,091 patients in 12 communities (of 16 targeted): 506 (220 intervention; 286 control) patients were seen by 30 physicians, and 585 (304 intervention; 281 control) were seen by 34 pharmacists. Mean age of the patients was 45 years (SD = 15), 68% were female, 78% white, 18% African American and 4% other ethnicities; 19% reported current smoking; and 3% reported other forms of tobacco use. At baseline, patients seen by a study pharmacist reported significantly lower rates of Asking about smoking behavior compared to patients seen by a study physician (7% vs. 32%, p < 0.01), in Advising patients to quit (8% vs. 49%, p < 0.01) and in Assessing patients’ readiness to quit (4% vs. 35%, p < 0.01). Low rates were observed in Assisting in and Arranging follow-up on smoking cessation among both physicians and pharmacists. In preliminary analysis, we compared the impact of our training program on the 5 A’s from baseline to 3 months. For patients counseled by a study physician, we have observed a significant increase in Asking about smoking (29% to 45% in the intervention group vs. 35% to 33% in the control group, p < 0.01). There was also a significant increase in Advising patients to quit (44% to 58% in the intervention group vs. 53% to 33% in the control group, p < 0.01). To date, statistically significant changes have not been observed in any of the smoking-cessation counseling activities among patients seen by pharmacists or the remainder three (Assess, Advise, Arrange follow-up) counseling activities for physicians. Our ongoing data collection will increase study power (targeted sample size for exit interviews is 1,568 individuals).
In the cohort study health care providers’ activities were assessed by their evaluation of patients’ cancer risk and adherence to the 5 A’s model documented during patient exit interviews from physicians’ offices/clinics and pharmacies. The interviews were conducted at the first patient visit after the training and at 3 months post-intervention. This intermediate analysis also compared the impact of the intervention at 3-month post-training on attempts to quit smoking as well as self-reported quit rates between intervention and control groups. A total of 533 (277 intervention; 256 control) patient smokers completed both the first on-site interview conducted shortly after their providers’ training and 3-month surveys from a total of 13 communities (out of 16 targeted). Mean age of the participants was 44 years (SD = 12), 71% were female, 69% white, 24% African American, and 7% other ethnicities. Forty-two percent were married, 51% had high school or less education, 34% had some college and 15% were college graduates. At the first interview, more than one half of participants responded yes to the question “Has a health care provider ever talked with you about your cancer risk?” (53% intervention, 54% control). Approximately 92% of the patients responded that a health care provider had asked them about tobacco use and 87% had been advised to quit. About 63% had been asked about physical activity and nutrition and 24% about sun protection. The majority reported that it was their physician who talked about their cancer risk during the past 12 months. There were no significant differences between the intervention and control groups. At the first interview after training, patients seen by a study pharmacist reported significantly lower rates of Asking about smoking behavior compared to patients seen by a study physician (7% vs. 39%, p < 0.01). Thirty-six percent of patients seen by a study physician were Advised to quit compared to 3% seen by pharmacists (p < 0.01). Similar trends were seen with respect to the other A’s of counseling. At the current preliminary phase of the study, there were no significant differences between intervention and control in any of the counseling practices. A total of 244 patients, who completed the first interview, have spoken directly with their health care provider before their 3-month interview. At 3 months post-intervention, 44% of physicians’ patients, who had not been Asked about tobacco use at the first visit, reported that they were Asked compared to 7% of patients seen by a pharmacist (p < 0.01). Out of 533 patients who completed the 3-month survey 195 (37%) made a serious attempt to quit. Nineteen percent of the patients reported quitting since the last interview, 57% reduced the number of cigarettes smoked, and 24% continued to smoke at the same rate. There were no significant differences between intervention and control or between physician and pharmacist in the patients’ quitting behavior; however, data collection is ongoing and subjects continue to be enrolled, thereby enhancing our study power.
Author 1: Alexander V. Prokhorov
Professor
1515 Holcombe
Dept. Behavioral Science
Houston
77030
United States
Author 2: Karen S. Hudmon
Author 3: Nancy Stancic Luca
Author 4: Salma Marani
Author 5: Ellen R. Gritz
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