Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs.
ABSTRACT This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members.
Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399-528 at each of nine health plans).
Of these smokers, 71% reported advice to quit, 56% were asked about their willingness to quit, 49% were provided some assistance in quitting (mostly self-help material or information about classes or counseling), and 9% were offered some kind of follow-up. Smokers receiving assistance in quitting reported higher satisfaction with their care.
In general, health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care. Compared with tobacco control efforts of a decade or more ago, considerable progress has been made. However, there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting.
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ABSTRACT: Objective : Although tobacco cessation training is included in many health profession programs, it is not yet routinely incorporated into chiropractic education. The purpose of this study was to assess the feasibility of incorporating a problem-based learning tobacco cessation activity into a lecture course for chiropractic students. Methods : Seventy-two students were assigned to participate in two 1-hour lectures on health promotion counseling and tobacco cessation followed by an experiential student-driven lab session using standardized patients at various stages of dependency and willingness to quit. The intervention was based on the transtheoretic model and the "5 A's" of counseling (ask, advise, assess, assist, arrange). Outcomes were assessed via (1) questionnaires completed by the standardized patients regarding the students' use of the 5A's, and (2) questionnaires completed by the students using a 5-point Likert scale of "strongly disagree" to "strongly agree" on the acceptability of this method of learning. Descriptive statistics were computed. Results : Sixty-eight students (94%) completed the activity, spending a median of 2.5 minutes with patients. Over 90% addressed 4 of the 5A's: 99% asked patients if they were smokers; 97% advised them to quit; 90% assessed if they were willing to quit; and 99% offered assistance in quitting. Only 79% arranged a follow-up visit. Overall, students expressed a positive response to the experience; 81% said it increased their confidence in being able to advise patients, and 77% felt it would be valuable for use in their future practice. Conclusion : This active learning exercise appeared to be a feasible way to introduce tobacco counseling into the curriculum.The Journal of chiropractic education 06/2013;
- 2010 edited by ANTIGONA TROFOR, 01/2010; Editura Tehnopress Iasi., ISBN: 978-973-702-768-9
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ABSTRACT: Frequently, one will find that the conditions for optimality in chemical production are determined by the non-linearities in the plant itself, while the economic objective function might be linear. If the control variables do not enter the objective function, it is found that the instantaneous optimal conditions are found where the product of the sensitivity matrix of the state variables to the control and the gradient of the objective function in the state space is zero. In some cases, this means that the process state is insensitive to the control at the optimum, which makes traditional proportional control instable. Therefore, the modeling and parameter estimation for process non-linearities to identify an optimum become essential. The control problem becomes a tracking problem. This paper describes the application of those ideas to a simple continuous stirred tank reactor with multi-component and multi-reaction kinetics.American Journal of Preventive Medicine - AMER J PREV MED. 01/1985;