Setting Up a Smoking Cessation Clinic · 2013-07-12 · Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN 3 ©2008 Johns Hopkins Bloomberg School of Public Health

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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© 2008 Johns Hopkins Bloomberg School of Public Health

Setting Up a Smoking Cessation Clinic

Sophia Chan PhD, MPH, RN, RSCNDepartment of Nursing StudiesThe University of Hong Kong

2© 2008 Johns Hopkins Bloomberg School of Public Health

Learning Objectives

To determine the vision, mission, and target population of thesmoking cessation clinic

To introduce the structure, process, and outcomes of setting up asmoking cessation clinic

To discuss the preparation of hardware and software for setting upthe clinic

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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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 smokingcessation services

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Vision and Mission

High-quality service

Compassionate patient care

Providing the best treatment

Enhancing quality of life

Integration of education, research, and clinical practice

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Target Population

General public

Hospitalized patients

Outpatients

Physician-referred

Self-referred

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Program Design

Adoption of evidence-based clinical practice guidelines (Fiore etal., 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

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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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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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

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Promotion and Publicity of the Clinic

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Training and Preparation of Counselors

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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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 thesmoker

Maintain clear and accurate records

Arrange follow-up

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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

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Health Education Materials

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Quitline

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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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 motivationalintervention (5Rs)

Arrange: follow-up and relapse prevention or re-engagement

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Program Model: 5Rs

Relevance

Risks

Reward

Road blocks

Repetition

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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The Cycle of Stopping Smoking

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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 intolifestyle

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Program Models: AWARD

Ask

Warn

Assess

Refer

Do it again

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Sample Quit Plan

Assessment of nicotine dependence (e.g., using the Fagerstromtest) and readiness to quit

Quit date

Physical addiction withdrawal management plan

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Sample Quit Plan

Psychological and behavioral management plan

Social and emotional management plan

Follow-up and relapse prevention plan

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Smoker Makes Appointment to See a Counselor

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Health Assessment of Smoker

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Carbon Monoxide (CO) Monitoring

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Individual Counseling

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Group Counseling

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Telephone Counseling

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Evaluation of Outcomes

Structure: site, equipment, staffing

Process: recruitment, fidelity of counseling intervention, cost-effectiveness

Outcomes: quit rate, quit attempts, smoking reduction, change ofstage

Biochemical-validated outcomes: urine or saliva cotinine

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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System Change Strategies

Implement a tobacco user identification system in the health caresetting

Promote clinic services through mass media and othercommunication channels

Provide education, resources, and feedback to promote the clinicservice

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System Change Strategies

Dedicate staff to provide smoking cessation intervention and assessperformance

Include smoking cessation treatments (counseling andpharmacotherapy) in health plans and health insurance

Reimburse clinicians for delivering smoking cessation treatmentsand include cessation treatment as part of their job duties

Setting Up a Smoking Cessation Clinic: Sophia Chan PhD, MPH, RN, RSCN

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Help Your Clients Quit Smoking TODAY!