2008 johns hopkins bloomberg school of public health setting up a smoking cessation clinic sophia...
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2008 Johns Hopkins Bloomberg School of Public Health
Setting Up a Smoking Cessation Clinic Setting Up a Smoking Cessation Clinic
Sophia Chan PhD, MPH, RN, RSCNDepartment of Nursing StudiesThe University of Hong Kong
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2 2008 Johns Hopkins Bloomberg School of Public Health
Learning Objectives
To determine the vision, mission, and target population of the smoking cessation clinic
To introduce the structure, process, and outcomes of setting up a smoking cessation clinic
To discuss the preparation of hardware and software for setting up the clinic
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3 2008 Johns Hopkins Bloomberg School of Public Health
Learning Objectives
To identify program models and components of the clinic
To discuss the evaluation of outcomes
To examine system change strategies in setting up smoking cessation services
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4 2008 Johns Hopkins Bloomberg School of Public Health
Vision and Mission
High-quality service
Compassionate patient care
Providing the best treatment
Enhancing quality of life
Integration of education, research, and clinical practice
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5 2008 Johns Hopkins Bloomberg School of Public Health
Target Population
General public
Hospitalized patients
Outpatients
Physician-referred
Self-referred
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6 2008 Johns Hopkins Bloomberg School of Public Health
Program Design
Adoption of evidence-based clinical practice guidelines (Fiore et al., 2000)
Routine identification of tobacco use
Integration into regular provision of care
Trained smoking cessation counselors—key to service delivery
Models of counseling
Evaluation of success
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7 2008 Johns Hopkins Bloomberg School of Public Health
The Structure: Hardware
Hardware The clinic site: hospital, outpatient clinics,
community centers Opening hours: office hours, evenings Mode of intervention: face-to-face, telephone,
Web-based Resources: staff, budget, equipment,
publicity, pharmacotherapy
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8 2008 Johns Hopkins Bloomberg School of Public Health
The Process: Software
Software Staffing: smoking cessation counselors,
administrators, research staff Training: basic, advance, assessments Quality assurance system: case conferences,
evaluation, continuing education Follow-up: frequency, measurements
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9 2008 Johns Hopkins Bloomberg School of Public Health
Promotion and Publicity of the Clinic
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10 2008 Johns Hopkins Bloomberg School of Public Health
Training and Preparation of Counselors
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11 2008 Johns Hopkins Bloomberg School of Public Health
The Smoking Cessation Counselor: Responsibilities
Establish rapport with smoker
Assess smoking history, nicotine dependence, and readiness to quit
Develop a clinical impression and prepare a quit plan
Provide counseling, health education, and relevant advice to the smoker
Maintain clear and accurate records
Arrange follow-up
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12 2008 Johns Hopkins Bloomberg School of Public Health
Treatment Components
Alliance with smoker, develop helping relationship
Individualized, group, telephone counseling
Health education materials, Web site
Addiction philosophy and approaches (e.g., Fagerstrom test)
Stage-matched interventions
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13 2008 Johns Hopkins Bloomberg School of Public Health
Health Education Materials
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14 2008 Johns Hopkins Bloomberg School of Public Health
Quitline
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15 2008 Johns Hopkins Bloomberg School of Public Health
Program Models: 5As and 5Rs
Ask: identify tobacco use at every visit
Advise: provide appropriate advice (individual vs. group)
Assess: stage of readiness to change
Assist: offer stage-matched interventions or motivational intervention (5Rs)
Arrange: follow-up and relapse prevention or re-engagement
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16 2008 Johns Hopkins Bloomberg School of Public Health
Program Model: 5Rs
Relevance
Risks
Reward
Road blocks
Repetition
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17 2008 Johns Hopkins Bloomberg School of Public Health
The Cycle of Stopping Smoking
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18 2008 Johns Hopkins Bloomberg School of Public Health
Source: Prochaska and DiClemente.
Transtheoretical Model of Change
Pre-contemplation: not ready to change
Contemplation: thinking about change
Preparation: getting ready to make change
Action: making the change
Maintenance: sustaining behavior change until integrated into lifestyle
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19 2008 Johns Hopkins Bloomberg School of Public Health
Program Models: AWARD
Ask
Warn
Assess
Refer
Do it again
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20 2008 Johns Hopkins Bloomberg School of Public Health
Sample Quit Plan
Assessment of nicotine dependence (e.g., using the Fagerstrom test) and readiness to quit
Quit date
Physical addiction withdrawal management plan
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21 2008 Johns Hopkins Bloomberg School of Public Health
Sample Quit Plan
Psychological and behavioral management plan
Social and emotional management plan
Follow-up and relapse prevention plan
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22 2008 Johns Hopkins Bloomberg School of Public Health
Smoker Makes Appointment to See a Counselor
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23 2008 Johns Hopkins Bloomberg School of Public Health
Health Assessment of Smoker
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24 2008 Johns Hopkins Bloomberg School of Public Health
Carbon Monoxide (CO) Monitoring
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25 2008 Johns Hopkins Bloomberg School of Public Health
Individual Counseling
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26 2008 Johns Hopkins Bloomberg School of Public Health
Group Counseling
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27 2008 Johns Hopkins Bloomberg School of Public Health
Telephone Counseling
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28 2008 Johns Hopkins Bloomberg School of Public Health
Evaluation of Outcomes
Structure: site, equipment, staffing
Process: recruitment, fidelity of counseling intervention, cost-effectiveness
Outcomes: quit rate, quit attempts, smoking reduction, change of stage
Biochemical-validated outcomes: urine or saliva cotinine
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29 2008 Johns Hopkins Bloomberg School of Public Health
System Change Strategies
Implement a tobacco user identification system in the health care setting
Promote clinic services through mass media and other communication channels
Provide education, resources, and feedback to promote the clinic service
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30 2008 Johns Hopkins Bloomberg School of Public Health
System Change Strategies
Dedicate staff to provide smoking cessation intervention and assess performance
Include smoking cessation treatments (counseling and pharmacotherapy) in health plans and health insurance
Reimburse clinicians for delivering smoking cessation treatments and include cessation treatment as part of their job duties
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31 2008 Johns Hopkins Bloomberg School of Public Health
Help Your Clients Quit Smoking TODAY!