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Impact of comprehensive smoking cessation training of practitioners on patients’ 6-month quit outcome

Abstract

Objectives

Smoking remains a leading public health issue and health care practitioners (HCPs), who play an important role in supporting and promoting patients’ cessation efforts, need educational initiatives that improve their ability to provide effective clinical care. The objective of this study was to compare patient-reported abstinence from smoking following treatment by HCPs trained in an intensive tobacco cessation program and those trained in less intensive programs.

Methods

A secondary data analysis of two overlapping samples of patients who received most of their treatment from one identifiable HCP (n = 26,590) or all of their treatment from one identifiable HCP (n = 20,986) was assessed. Patients were residents of Ontario, Canada, who enrolled in a publicly funded smoking cessation treatment program between 01 May 2014 and 31 October 2016 and completed the 7-day point prevalence of smoking question at 6-month follow-up. Treatment was provided by HCPs who engaged in the intensive Training Enhancement in Applied Counselling and Health (TEACH) Core course, or those who engaged in one or more other training programs. Generalized estimating equation (GEE) logistic regression was used to compare smoking abstinence between groups.

Results

After adjustment for both patient- and practice-level covariates, a significant association was found between being treated by a TEACH-trained HCP and the likelihood of smoking abstinence at 6-month follow-up in both analytic samples (most care sample: OR = 1.10, 95% CI = 1.01, 1.20; all care sample: OR = 1.12, 95% CI = 1.02, 1.24).

Conclusion

Implementation of comprehensive cessation training to support HCP delivery of smoking cessation treatment should be considered to improve patient outcomes.

Résumé

Objectifs

Le tabagisme demeure l’un des principaux problèmes de santé publique et les praticiens des soins de santé (PSS), qui jouent un rôle important en encourageant et en aidant leurs patients à cesser de fumer, ont besoin de programmes de formation pour améliorer leur capacité à prodiguer des soins cliniques efficaces. La présente étude a pour but de comparer l’abstinence tabagique déclarée par les patients traités par un PSS formé dans le cadre d’un programme intensif d’abandon du tabac et celle déclarée par des patients traités par un PSS formé dans le cadre d’un programme moins intensif.

Méthodes

On a évalué l’analyse de données secondaires portant sur deux échantillons chevauchants de patients ayant reçu la majeure partie de leur traitement d’un seul PSS identifiable (n = 26 590) ou la totalité de leur traitement d’un seul PSS identifiable (n = 20 986). Les patients résidaient en Ontario, au Canada, et s’étaient inscrits à un programme d’abandon du tabac financé à même les deniers publics, entre le 1er mai 2014 et le 31 octobre 2016, et, six mois plus tard, avaient rempli le questionnaire de suivi de sept jours sur la prévalence ponctuelle du tabagisme. Le traitement avait été fourni par des PSS qui avaient suivi le cours intensif de base du programme TEACH (Training Enhancement in Applied Counselling and Health), ou par ceux qui avaient participé à un ou plusieurs autres programmes de formation. Pour comparer l’abstinence tabagique entre les groupes, on s’est servi de la régression logistique à l’aide d’un modèle d’équation d’estimation généralisée (EEG).

Résultats

Après rajustement en fonction des covariantes au niveau des patients et des cabinets, on a observé une association significative entre les patients traités par un PSS ayant participé au programme TEACH et la probabilité d’une abstinence tabagique dans le cadre du suivi de six mois, et ce, dans les deux échantillons analysés (échantillon de patients ayant reçu la majeure partie de leur traitement d’un tel PSS : RC = 1,10, IC à 95 % = 1,01, 1,20; échantillon de patients ayant reçu la totalité de leur traitement d’un tel PSS : RC =1,12, IC à 95% =1,02, 1,24).

Conclusion

On devrait envisager la possibilité d’offrir une formation complète sur l’abandon du tabagisme en vue d’appuyer les PSS qui traitent des patients désireux d’arrêter de fumer et d’améliorer ainsi les résultats pour la santé de ces derniers.

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Acknowledgements

The authors thank Arezoo Ebnahmady who contributed to initial discussions of the study design and Ahmad Mobin who performed preliminary data cleaning. Peter Selby would like to acknowledge salary support for his clinician-scientist position from the Centre for Addiction and Mental Health and the Department of Family and Community Medicine at the University of Toronto.

Funding

Funding for the Smoking Treatment for Ontario Patients (STOP) and Training Enhancement in Applied Counselling and Health (TEACH) programs was provided by the Ministry of Health and Long-Term Care (MOHLTC), as part of the Smoke Free Ontario Strategy. The findings in and conclusions of this study are those of the authors and do not necessarily represent the official position of the MOHLTC. This study did not receive any external funding.

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Corresponding author

Correspondence to Peter Selby.

Ethics declarations

This study was approved by the Research Ethics Board of the Centre for Addiction and Mental Health (CAMH). Informed consent was obtained from all individual participants prior to collection of any study data.

Conflict of interest

Dolly Baliunas and Peter Selby report grants from Pfizer Inc. through the Global Research Awards in Nicotine Dependence (GRAND) program. In the last 5 years, Peter Selby additionally reports grants from Pfizer Inc./Pfizer Canada, Bhasin Consulting Fund, Shoppers Drug Mart, and Patient-Centered Outcomes Research Institute; has received honoraria for speaking engagements from Pfizer Canada Inc., ABBVie, and Bristol-Myers Squibb; and has also received consulting fees from Pfizer Inc./Pfizer Canada, Evidera Inc., Johnson & Johnson Group of Companies, Medcan Clinic, Miller Medical Communications, MedPlan Communications, NVision Insight Group, Inflexxion Inc., Kataka Medical Communications, Sun Life Financial, and Myelin & Associates. Through an open tender process, Johnson & Johnson, Novartis, and Pfizer Inc. are vendors of record for providing smoking cessation pharmacotherapy, free or discounted, for research studies in which Peter Selby is the principal investigator or co-investigator. Anna Ivanova, Elise Tanzini, and Rosa Dragonetti declare that they have no conflict of interest.

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Baliunas, D., Ivanova, A., Tanzini, E. et al. Impact of comprehensive smoking cessation training of practitioners on patients’ 6-month quit outcome. Can J Public Health 111, 766–774 (2020). https://doi.org/10.17269/s41997-020-00318-1

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Keywords

  • Smoking cessation
  • Treatment outcome
  • Professional education
  • Tobacco use disorder

Mots-clés

  • Abandon du tabagisme
  • résultats du traitement
  • formation professionnelle
  • trouble de l’usage du tabac