Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation.

OBJECTIVE: To evaluate the feasibility of an online training module, Certified Smoking Cessation Service Provider (CSCSP), developed for practicing pharmacists to equip pharmacy students with knowledge necessary for smoking cessation counseling and to assess the changes in student knowledge and skills regarding smoking cessation following training. DESIGN: Sixty third-year and 80 fourth-year pharmacy undergraduates (N=140) were given access to an online module, the main intervention in the study. Two linkable questionnaires were administered to assess students' preintervention and postintervention knowledge. For the third-year students, an additional role-play training component was incorporated, and student skills were assessed during week 14 with an Objective Structured Clinical Examination (OSCE). ASSESSMENT: Preintervention and postintervention knowledge assessments were completed by 130 (92.8%) students. Sixty-six students scored above 50% for the knowledge component postintervention, compared to 13 at preintervention, demonstrating significant improvement (x2(1, N=130)=32, p=0.003). All third-year students completed the intervention, and 66.7% were able to counsel excellently for smoking cessation, scoring more than 80%. CONCLUSION: The CSCSP online module developed for practicing professionals was found suitable for equipping pharmacy undergraduates with knowledge on smoking cessation topics. The module, along with role-play training, also equipped students with knowledge and skills to provide smoking cessation counseling.

Tobacco-related medical education and physician interventions with parents who smoke: Survey of Canadian family physicians and pediatricians.

OBJECTIVE: To examine the relationship between physicians' tobacco-related medical training and physicians' confidence in their tobacco-related skills and smoking-related interventions with parents of child patients. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: The survey was mailed to 800 family physicians and 800 pediatricians across Canada, with a corrected response rate of 65% (N = 900). MAIN OUTCOME MEASURES: Physicians' self-reported tobacco-related education, knowledge, and skills, as well as smoking-related interventions with parents of child patients. Cochran-Mantel-Haenszel chi(2) tests were used to examine relationships between variables, controlling for tobacco-control involvement and physician specialty. Data analysis was conducted in 2008. RESULTS: Physicians reporting tobacco-related medical education were more likely to report being "very confident" in advising parents about the effects of smoking and the use of a variety of cessation strategies (P < .05). Furthermore, physicians with tobacco-related training were more likely to help parents of child patients quit smoking whether or not the children had respiratory problems (P < .05). Physicians with continuing medical education in this area were more likely to report confidence in their tobacco-related skills and to practise more smoking-related interventions than physicians with other forms of training. CONCLUSION: There is a strong relationship between medical education and physicians' confidence and practices in protecting children from secondhand smoke. Physicians with continuing medical education training are more confident in their tobacco-related skills and are more likely to practise smoking-related interventions than physicians with other tobacco-related training.

Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study.

OBJECTIVE: To describe the characteristics at enrollment and outcomes of doctors in a substance dependence monitoring programme in Canada. DESIGN: Prospective descriptive study. SETTING: Provincial physician health programme, Canada. PARTICIPANTS: All 100 doctors consecutively admitted to a substance dependence monitoring programme and followed until completion of monitoring or on leaving the programme. MAIN OUTCOME MEASURE: Relapse during long term monitoring for five years. RESULTS: Ninety per cent of the doctors enrolled on the programme were men, 66% were married or living with a partner, 44% had had previous treatment for substance dependence, and 36% had had previous psychiatric treatment. Smokers were over-represented compared with the general population of US doctors (38% v 5%). During the monitoring period 71% of participants had no known relapse. An additional 14% went on to complete the programme, after some form of relapse. In total, 85% of the doctors successfully completed the programme. CONCLUSION: In this cohort of doctors enrolled on the Ontario Physician Health Program for substance dependence, most were men who were dependent on alcohol or opioids. Smokers were over-represented compared with the general population of US doctors. Eighty five per cent successfully completed the programme.

Views of Ontarians about health professionals' smoking cessation advice.

BACKGROUND: Health professionals have important roles in helping smokers quit. However, it is not known how the public, especially smokers, view smoking cessation advice from different health professionals. METHODS: We added questions regarding opinions and experiences with health professionals' smoking cessation advice to the 2002 CAMH Monitor, an annual random-digit-dialled survey of adult Ontarians. We report on how good a source of advice physicians, pharmacists, and dentists are perceived to be, how likely smokers are to consult each of these professionals, who smokers would ask for advice on the use of NRT, and advice received by smokers in the past year. RESULTS: About two thirds of respondents viewed physicians as a very good source of advice on quitting, compared to just over one third and about one quarter who thought this of pharmacists and dentists, respectively. Over half of current smokers would be very likely to ask a physician for quit advice, compared to about 20% and only 3% for a pharmacist or a dentist, respectively. Among smokers, over 40% would first ask a physician for advice on NRT; about 20% would first ask a pharmacist. About 42% and 8% of current smokers reported that they received advice in the past year from a physician and pharmacist, respectively. INTERPRETATION: Smokers are receptive to quit advice from physicians, but less likely to ask other health professionals. Few smokers received advice from pharmacists and dentists. Increasing the reach of quit advice requires both increased professional intervention and education of the public.

Do total smoking bans affect the recruitment and retention of adolescents in inpatient substance abuse treatment programs? A 5-year medical chart review, 2001-2005.

Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population ( approximately 80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between cigarette-smoking bans and key clinical outcomes. The current study examined the medical charts of all adolescents (N = 520) admitted to the only adolescent hospital-based substance abuse treatment program in the northern two thirds of the province of British Columbia, Canada. During the span of the study period (March 2001-December 2005), the treatment site moved from a partial smoking ban to a total smoking ban, and then retreated to partial smoking ban. The total smoking ban was not associated with a lower proportion of adolescent smokers seeking treatment at the facility or a lower treatment completion rate among smokers. Total smoking bans do not appear to be an obstacle for adolescent smokers seeking residential substance abuse treatment, nor do total smoking bans appear to compromise the treatment completion rates of smokers in comparison to nonsmokers. Despite these null findings, the effective implementation of smoke-free policies in adolescent substance abuse treatment programs requires not only large-scale organizational change but also the transformation of current commonly held beliefs about tobacco dependence in addictions treatment and recovery communities.

Pharmacists' smoking cessation practices: relationship to their knowledge and skills, attitudes, and perceptions of roles.

OBJECTIVE: To assess factors associated with pharmacists' practices regarding patients' smoking and smoking cessation. DESIGN: Cross-sectional analysis. SETTING: Four Canadian provinces (Ontario, Québec, Saskatchewan, Prince Edward Island). PARTICIPANTS: Practicing community pharmacists (n = 906; weighted n = 897). INTERVENTION: Population-based mailed questionnaire survey with 72% response rate. MAIN OUTCOME MEASURES: Bivariate and multivariate relationships between 12 clinical interventions regarding smoking and smoking cessation and 7 domains: basic pharmacologic knowledge; applied health science knowledge and skills; positive, negative and economic-related attitudes toward smoking cessation; perceptions of pharmacists' roles with patients who smoke: assessing and motivating patients; assisting, referring and following up. RESULTS: Basic pharmacologic knowledge and applied health science knowledge and skills were independently related to 12 and 10 interventions, respectively. Positive attitudes toward smoking cessation were independently related to 8 interventions. Negative attitudes and economic-related attitudes toward smoking cessation were each independently related to only 1 intervention. Perceptions of pharmacists' roles with respect to "assessing and motivating patients," and "assisting, referring, and following up" were independently related to 8 and 3 interventions, respectively. CONCLUSION: Initiatives to increase tobacco-related knowledge and skills and enhance positive attitudes and role perceptions with respect to smoking and smoking cessation may promote interventions by community pharmacists with patients who smoke.

Family medicine residents' beliefs, attitudes and performance with problem drinkers: a survey and simulated patient study.

Fifty-six second-year family medicine residents completed a survey on their knowledge and beliefs about problem drinkers. Most residents felt responsible for screening and counseling, were confident in their clinical skills in these areas, and scored well on related knowledge questions. However, only 18% felt that problem drinkers would often respond to brief counseling sessions with physicians while 36% felt that moderate drinking was a reasonable goal for patients with severe alcohol dependence. Residents were then visited by unannounced simulated patients (SPs) presenting with alcohol-induced hypertension or insomnia. Residents detected the SP in 45 out of 104 visits. In the 59 undetected SP visits, residents asked about alcohol consumption in 47 visits (80%), discussed the relationship between alcohol use and the presenting complaint in 37 visits (63%), and recommended a specific weekly consumption in 35 visits (59%). Only 31% offered reduced drinking strategies, and most did not ask about features of alcohol dependence. These results suggest that residents have the fundamental clinical skills required to manage the problem drinker who gives a clear history and is receptive to advice. Educational efforts with residents should focus on the importance of systematic screening, taking an alcohol history under more challenging conditions, identifying the subtler presentations of alcohol problems, counselling the less receptive patient at an earlier stage of change, distinguishing the problem drinker from the alcohol-dependent patient, and offering specific behavioral strategies for the problem drinker.

Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers.

BACKGROUND: Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. PURPOSE: To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. METHODS: Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. RESULTS: SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents' checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP "did not act like a drinker" and was of a different social class than the typical clinic patient. CONCLUSIONS: Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians' actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians' poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians' clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

Physician behavior towards male and female problem drinkers: a controlled study using simulated patients.

BACKGROUND: Evidence suggests that physicians are less likely to identify alcohol problems in females than in males. PURPOSE: To compare the performance of family medicine residents with male and female simulated patients (SPs) posing as problem drinkers. METHODS: Fifty-six family medicine residents completed a baseline survey on knowledge and attitudes towards problem drinkers. Each resident was then visited by one male and female unannounced SP. The male and female roles were similar with respect to presenting complaint (in somnia or hypertension), age, social class, and drinking history. RESULTS: Residents expressed slightly more positive attitudes towards female than male patients (3.32 vs. 3.09, p < .001). Residents scored higher with undetected male than with undetected female SPs on the assessment checklist (5.1 vs. 3.2, p < .045), the management checklist (4.4 vs. 3.2, p = .032), and an interpersonal rating scale (the Alcohol Skills Rating Form; 5.5 vs. 4.7, p = .023). CONCLUSION: Educational programs should focus on improving physicians' clinical skills in the identification and treatment of alcohol problems in women.