Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial.
ABSTRACT To evaluate the effectiveness of two teaching interventions to increase residents' performance of smoking cessation counseling.
Randomized controlled factorial trial.
Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals.
261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months.
Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention.
Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5-1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76-79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3-8.2%; biochemically verified: 3.4-5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant.
A simple and feasible educational intervention can increase residents' smoking cessation counseling.
- SourceAvailable from: Nouf Alhammad
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- "Providing education during residency training, before practice patterns have become rigidly established, has been successful. It has been reported that integration of an early childhood caries prevention program into the clinical medical education curriculum resulted in dental caries becoming the eleventh most common diagnosis seen in the clinic, when previously it did not appear in the top 40.30–32 In contrast, delivering effective education after completion of residency training is challenging, given that the evidence suggests traditional ongoing didactic medical education does not improve physician performance.33 "
ABSTRACT: This study evaluated the effectiveness of an infant oral health care educational intervention on the knowledge of female dental students at King Saud University in Riyadh city. One hundred and twenty-eight students participated in the study. The participants were from different levels in the dental college, ie, second year (D2), third year (D3), fourth year (D4), and fifth year (D5). Assessment by questionnaire was completed immediately before and after a 14-minute educational intervention, in the form of a PowerPoint presentation and video on oral health of infants for dental students. The 18-item multiple-choice questionnaire was based on information presented in the presentation. A significant difference (P < 0.001) was found between average pretest scores (9.30 ± 2.24), and average post-test scores (12.56 ± 2.05). The highest percentage of improvement in the post-test as compared with the pretest was recorded for group D2 (50.6%) followed by D3 (40%), D4 (35%), and D5 (23%). One hundred and twenty-six (98.4%) study participants found the presentation helpful in improving their understanding of infant oral health, and 77 (60.2%) were very satisfied with the presentation. Sixty-six participants (51.6%) reported that the presentation was very effective in teaching them about infant oral health, and 83 (65%) were very likely to incorporate this information into their daily practice. A 14-minute PowerPoint and video educational intervention was effective in teaching basic information about infant oral health to dental students.08/2011; 2:193-9. DOI:10.2147/AMEP.S19415
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- "Whether these barriers apply in the South African context is not yet known and further studies are needed to determine this. Nevertheless, training health care practitioners in tobacco cessation counseling is crucial and has been shown to improve both counseling rates and the quality of support given to patients who want to quit cigarette smoking[26,27]. "
ABSTRACT: Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations. This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis. Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88). Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.BMC Family Practice 11/2010; 11:94. DOI:10.1186/1471-2296-11-94 · 1.74 Impact Factor
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- "Most of the questions in this study were derived from previous empirical studies (Kenney et al, 1988; Strecher et al, 1991). Those questions were translated by the first author and a research assistant (both bilingual) and back-translated into English. "
ABSTRACT: A survey of Chinese physicians' cigarette smoking habits and their counselling of patients to quit smoking was carried out in two provincial hospitals in Wuhan, capital city of Hubei province, People's Republic of China. All 559 physicians in the two hospitals were given the questionnaire, of which 86% (480) returned their completed questionnaires. Of the 480 physicians, 50.9% of the males, and 4.8% of the females were current cigarette smokers. The majority of physicians (85.6%) had counselled their patients about cigarette smoking in the past year, although few physicians (2.9%) felt that they were very successful in helping patients to quit smoking. The frequency of physicians' anti-smoking counselling was significantly correlated with a number of variables: physicians' own smoking status; whether they perceived themselves as the most influential people in helping patients to quit smoking; whether physicians thought that they were successful in their past counselling practices; and physicians' age.Health Promotion International 06/1996; 11(2). DOI:10.1093/heapro/11.2.89 · 1.94 Impact Factor