Learning to assist smokers through encounters with standardized patients: An innovative training for physicians in an Eastern European country


Autoři: Narine K. Movsisyan aff001;  Varduhi Petrosyan aff001;  Gohar Abelyan aff001;  Ondrej Sochor aff002;  Satenik Baghdasaryan aff003;  Jean-François Etter aff004
Působiště autorů: American University of Armenia, Gerald and Patricia Turpanjian School of Public Health, Yerevan, Armenia aff001;  International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic aff002;  Yerevan State Medical University, Department of Postgraduate and Continuing Medical Education, Yerevan, Armenia aff003;  Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Geneva, Switzerland aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222813

Souhrn

Objectives

A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence.

Study design

The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment.

Methods

We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians’ self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians’ counselling skills measured on ordinal scale.

Results

Of the 37 residents trained, 75% were female, 89% aged 20–29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications.

Conclusions

Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations.

Klíčová slova:

Cardiology – Drug therapy – Europe – Patients – Physicians – Questionnaires – Smoking habits – Armenia


Zdroje

1. WHO report on the global tobacco epidemic. Geneva: World Health Organization; 2015.

2. Rigotti NA, Bitton A, Richards AE, Reyen M, Wassum K, Raw M. An International Survey of Training Programs for Treating Tobacco Dependence. Addiction 2009;104(2):288–96. doi: 10.1111/j.1360-0443.2008.02442.x 19149826

3. Cornuz J, Humaír J-P, Seematter L, Stoianov R, van Melle G, Stalder H, et al. Efficacy of resident training in smoking cessation: a randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients. Ann Int Med. 2002;136(6):429–37. doi: 10.7326/0003-4819-136-6-200203190-00006 11900495

4. Geller AC, Zapka J, Brooks KR, Dube C, Powers CA, Rigotti N, et al. Tobacco control competencies for US medical students. Am J Public Health. 2005;95(6):950–5. Epub 2005/05/26. doi: 10.2105/AJPH.2004.057331 15914815.

5. Reile R, Pärna K. Do physicians address their patients’ smoking behavior? Results from a nationwide survey among physicians in Estonia. Public Health. 2018;161:1–4. https://doi.org/10.1016/j.puhe.2018.02.009 29804054

6. Warren CW, Sinha DN, Lee J, Lea V, Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005–2008. BMC Public Health. 2011;11:72. Epub 2011/02/03. doi: 10.1186/1471-2458-11-72 21284864.

7. Kralikova E, Bonevski B, Stepankova L, Pohlova L, Mladkova N. Postgraduate medical education on tobacco and smoking cessation in Europe. Drug and Alcohol Review. 2009;28(5):474–83. doi: 10.1111/j.1465-3362.2009.00104.x 19737206

8. Humair JP, Cornuz J. A new curriculum using active learning methods and standardized patients to train residents in smoking cessation. J Gen Intern Med. 2003;18(12):1023–7. Epub 2003/12/23. doi: 10.1111/j.1525-1497.2003.20732.x 14687261.

9. Fiore M. Treating tobacco use and dependence: 2008 update. Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service; 2008. xvii, 256 p.

10. Steinberg MB, Delnevo CD. Physician beliefs regarding effectiveness of tobacco dependence treatments: results from the NJ health care provider tobacco survey. Journal of General Internal Medicine. 2007;22(10):1459–62. doi: 10.1007/s11606-007-0282-5 17726636

11. Ockene JK, Hayes RB, Churchill LC, Crawford SL, Jolicoeur DG, Murray DM, et al. Teaching medical students to help patients quit smoking: outcomes of a 10-school randomized controlled trial. J Gen Intern Med. 2016;31(2):172–81. Epub 2015/09/24. doi: 10.1007/s11606-015-3508-y 26391030

12. Carson KV, Verbiest ME, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ, et al. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2012;5:Cd000214. Epub 2012/05/18. doi: 10.1002/14651858.CD000214.pub2 22592671.


Článek vyšel v časopise

PLOS One


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Krvácení v důsledku portální hypertenze při jaterní cirhóze – od pohledu záchranné služby až po závěrečný hepato-gastroenterologický pohled
nový kurz
Autoři: PhDr. Petr Jaššo, MBA, MUDr. Hynek Fiala, Ph.D., prof. MUDr. Radan Brůha, CSc., MUDr. Tomáš Fejfar, Ph.D., MUDr. David Astapenko, Ph.D., prof. MUDr. Vladimír Černý, Ph.D.

Rozšíření možností lokální terapie atopické dermatitidy v ordinaci praktického lékaře či alergologa
Autoři: MUDr. Nina Benáková, Ph.D.

Léčba bolesti v ordinaci praktického lékaře
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se