RESEARCH PAPER
Impact of the Tobacco Treatment Guidelines for High Risk Groups (TOB.g): A pilot study among physicians specializing in CVD, Diabetes and COPD
 
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1
University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
2
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
3
Faculty of Medicine, University of Ottawa, Ottawa, Canada
4
Institute of Public Health, American College of Greece, Athens, Greece
5
George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
6
Hellenic Centre for Disease Control and Prevention, Athens, Greece
7
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Publish date: 2018-04-21
Submission date: 2017-12-20
Final revision date: 2018-03-20
Acceptance date: 2018-03-20
 
Tob. Prev. Cessation 2018;4(April):13
KEYWORDS:
TOPICS:
ABSTRACT:
Introduction:
The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, selfefficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes.

Methods:
A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training.

Results:
Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy.

Conclusions:
Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

CORRESPONDING AUTHOR:
Lucia Maria Lotrean   
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
 
REFERENCES (31):
1. Behrakis P, Vardavas C, Papadakis S. (Eds.). Tobacco Cessation Guidelines for High Risk Groups. Athens: Hellenic Center for Disease Control and Prevention (KEELPNO); 2017.
2. USDHHS. The Health Consequences of Smoking—50 Years of Progress: A report of the Surgeon General. U.S. Department of Health and Human Services, 2015. http://www.surgeongeneral.gov/.... Accessed December, 2017.
3. Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2010. www.goldcopd.org Accessed December, 2017.
4. Pan A, Wang Y, Talaei M, Hu FB. Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus A Meta-Analysis and Systematic Review. Circulation. 2015 Nov 10;132(19):1795-804. doi: 10.1161/CIRCULATIONAHA.115.017926
5. Tonstad S, J. AJ. Cardiovascular risks associated with smoking: a review for clinicians. Eur J Cardiovasc Prev Rehabil. 2006;13(4):507-14. doi: 10.1097/01.hjr.0000214609.06738.62
6. Mohiuddin SM1, Mooss AN, Hunter CB, Grollmes TL, Cloutier DA, Hilleman DE. Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest. 2007;131(2):446-52. doi:10.1378/chest.06-1587
7. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97. doi: 10.1001/jama.290.1.86
8. Fogt F, Hall S, Marteau TM. General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction. 2005;100(10):1423-31. doi: 10.1111/j.1360-0443.2005.01221.x
9. Eldein HN, Mansour NM, Mohamed SF. Knowledge, Attitude and Practice of Family Physicians Regarding Smoking Cessation Counseling in Family Practice Centers, Suez Canal University, Egypt. J Family Med Prim Care. 2013;2(2):159-163. doi: 10.4103/2249-4863.117411
10. Jiménez-Ruiz CA, Andreas S, Lewis KE, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015 ;46(1):61-79. doi: 10.1183/09031936.00092614
11. McIvor A, Kayser J, Assaad JM, et al. Best practices for smoking cessation interventions in primary care. Can Respir J. 2009 Jul-Aug;16(4):129-34. doi: 10.1155/2009/412385
12. Behrakis P. TOB-G: Tobacco Cessation Guidelines for High Risk Populations. Tob. Prev. Cessation 2016;2(April Supplement):39. doi: 10.18332/tpc/62428
13. Guyatt G, Oxman A, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. doi: 10.1136/bmj.39489.470347.AD.
14. O'Loughlin J, Makni H, Tremblay M, et al. 2001. Smoking cessation counseling practices of general practitioners in Montreal. Prev Med. 2001;33(6):627-38. doi:10.1006/pmed.2001.0937
15. Schnoll RA, Rukstalis M, Wileyto EP, and AE Shields. Smoking cessation treatment by primary care physicians: An update and call for training. Am J Prev Med 2006;31(3):233-239. doi: 10.1016/j.amepre.2006.05.001
16. Papadakis S, Pipe AL, Reid RD, Tulloch H, Mullen K, Assi R, Cole A, Wells G. Effectiveness of performance coaching for enhancing rates of smoking cessation treatment delivery by primary care providers: Study protocol for a cluster randomized controlled trial. Contemp Clin Trials. 2015;45(Pt B):184-190. doi: 10.1016/j.cct.2015.08.013
17. Girvalaki C., Papadakis S., Vardavas C., Pipe A., and C. Lionis. Tobacco treatment TrAining Network in Crete (TiTAN-Crete): protocol for a controlled before-after study. Tob. Prev. Cessation 2016;2(June):67 doi: 10.18332/tpc/63823.
18. Delucchi KL, Tajima B, Guydish J. Development of the smoking knowledge, attitudes, and practices (S-KAP) instrument. J Drug Issues. 2009;39(2):347-364. doi: 10.1177/002204260903900207
19. Ampt AJ, Amoroso C, Harris MF, et al. Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice 2009;10:59. doi: 10.1186/1471-2296-10-59
20. Benson F, Nierkens V, Stronks K, Willemsen M. Effects of different types of smoking cessation behavioral therapy in disadvantaged areas in the Netherlands: an observational study. Tob. Prev. Cessation 2016;2:14 doi:10.18332/tpc/61616
21. Martínez C, Castellano Y, Andrés A,et al. Factors associated with implementation of the 5A's smoking cessation model. Tob Induc Dis. 2017:15:41. doi: 10.1186/s12971-017-0146-7.
22. Qaseem A, Wilt T, Weinberger SE, et al. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine 2011;155(3):179-191. doi: 10.7326/0003-4819-155-3-201108020-00008
23. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care 2017;40(1): S132-S135. doi: 10.2337/dc17-in01
24. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, and M Marre. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD-summary. Diabetes & Vascular Disease Research. 2014:11(3); 133-73. doi: 10.1177/1479164114525548
25. Piepoli MF, Hoes AW, Agewall S. Albus C, Brotons C, Catapano AL, and Graham, I. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European Heart Journal. 2016;37(29): 2315-2381. doi: 10.1093/eurheartj/ehw106
26. Mostofian F, Ruban C, Simunovic N, Bhandari M.Changing physician behavior: what works? Am J Manag Care. 2015;21(1):75-84.
27. Carson KV, Verbiest ME, Crone MR, et al. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2012. CD000214. doi: 10.1002/14651858.CD000214.pub2
28. Papadakis S, McDonald P, Reid RD, Pipe A, Mullen K, and K Skulsky. Strategies to improve the delivery of smoking cessation treatments in primary care: A systematic review and meta-analysis. Prev Med. 2010;51(3-4):199-213. doi: 10.1016/j.ypmed.2010.06.007
29. Purkabiri K, Steppacher V, Bernardy K, et al. Outcome of a four-hour smoking cessation counselling workshop for medical students. Tob Induc Dis. 2016;14:37. doi: 10.1186/s12971-016-0103-x
30. Pascal OI, Trofor A, Lotrean M, Filipeanu D, Trofor L. Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life. Tob Induc Dis. 2017;15:23. doi: 10.1186/s12971-017-0128-9
31. Papadakis S, Gharib M, Hambleton J, Reid RD, Assi R, and AL Pipe. Delivering evidence-based smoking cessation treatment: The experience of Ontario Family Health Teams. Canadian Family Physician 2014;60:e362-71. PMCID: PMC4096282.
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