A 12-month longitudinal outcomes and process evaluation of the adapted Certified Tobacco Treatment Specialist (aCTTS) program for physicians in the Former Yugoslav Republic of Macedonia (FYROM)
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Henry Ford Health System, Global Health Initiative, United States
Faculty of Medicine, University of Sts. Cyril and Methodius, FYROM
Maria Sklodowska-Curie Institute - Oncology Centre, Poland
Henry Ford Health System Center for Health Promotion and Disease Prevention, United States
Henry Ford Health System Department of Pulmonary and Critical Care Medicine, United States
Publication date: 2019-03-26
Tob. Prev. Cessation 2019;5(Supplement):A63
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A Certified Tobacco Treatment Specialist (CTTS) program was adapted to address socio-cultural contexts of tobacco use in FYROM. The training objectives were to increase provider knowledge regarding tobacco use and risks; increase provider self-efficacy for patient counseling; decrease tobacco use among providers; and document provider counseling during post-intervention clinic appointments.

A survey was conducted at baseline, and 6- and 12-months post-intervention. Bivariate and multivariate analyses were conducted to determine significant changes across time and refine associations between independent and dependent variables. Weekly logbook data documented numbers of patients counseled and time spent counseling.

Of 97 participants who completed baseline, 72 (74.2%) completed the 12-month survey. Scores on a 30-item knowledge scale increased between baseline (10.5), 6-month (18.9) and 12-month (20.7) post-intervention (p<0.001). Between baseline and 12 months, perceived barriers to engaging with patients regarding tobacco use decreased (p=0.001) and confidence in providing tobacco treatment counseling increased (p=0.046). At baseline and 12-month post-intervention respectively, 29% and 20% of respondents reported current smoking (p<.001). Providers’ interest or engagement in quitting tobacco increased significantly between baseline and 6-month (p=0.026) and 12-month (p=0.019) post-intervention. Logbook data indicate that 39% of patient visits were tobacco related with 78% of those patients receiving counseling.

There is an urgent need for tobacco-focused education among health providers in FYROM. The adapted CTTS program was well-received. Data indicate physicians are engaging in tobacco counseling, with increased knowledge and greater confidence. Future efforts include expanding training in FYROM and possibly elsewhere in the Balkan region.

Pfizer Grants for Learning and Change (European Division) and the Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, USA.
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