Description (provided by applicant):
Physicians are in a unique position to serve as a cornerstone for the nation's
tobacco prevention and cessation efforts, having both access to the entire
inventory of quitting aids and commanding a level of respect which makes them
particularly influential. While influential, however, studies show that the
majority of physicians report not counseling patients in smoking cessation due
to lack of time, training and reimbursement. Increased physician/pharmacist
collaboration can be used to address time constraints, since pharmacists have
been identified as the most accessible health care providers in the community.
In addition, training of physicians, their support staff, and pharmacists has
been shown to improve skills and motivation for cessation counseling.
The proposed project, a collaborative effort of researchers at the M. D.
Anderson Cancer Center (Houston, TX) and SRI International (Menlo Park, CA),
will integrate and enhance three existing initiatives for training health care
providers in effective tobacco cessation counseling. The creation and
implementation of specialty-specific training modules (one for physicians and
their staff, one for pharmacists) will establish a network of trained
providers, and a linkage system facilitated by media communications will be
used to facilitate referrals and support among providers. Additional media
will be used to inform community members (potential patients in need of
cessation support) of the availability of the trained healthcare provider
network. This combination of training health care providers and informing all
levels of patient and provider networks is expected to greatly increase both
delivery and utilization of the Clinical Practice Guidelines for Treating
Tobacco Use and Dependence.
Cohort, cross-sectional and pre-post measures will be used. Health care
provider practices, patient tobacco use behavior change, and community-level
outreach will be examined. Specific aims of this study are:
AIM 1: To develop an accredited continuing education training program for each
of the target health care provider groups.
AIM 2: To implement the training program among a minimum of 560 providers (280
physicians and 280 pharmacists) in seven communities located throughout Texas,
using live presentations, broadcasts via satellite, videotaped presentations,
and web-based training.
AIM 3: AIM 3: To evaluate the impact of the training program in
group-randomized trials among healthcare providers and their patients,
comparing seven trained and networked intervention communities to seven
AIM 4: To use media and opinion leader networking channels to facilitate
linkages among health care practitioners and between practitioners and the
community publicizing a web of trained and accessible tobacco cessation
counselors. Also, to encourage and facilitate health care provider outreach in
AIM 5: To evaluate the proposed tobacco cessation counseling strategies for
their costs and benefits.
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