Text messaging interventions to support smoking cessation among hospitalized patients in Brazil: a randomized comparative effectiveness clinical trial.

OBJECTIVE: A clinical trial carried out in patients hospitalized for clinical and surgical conditions. This study evaluated the effectiveness of text messaging interventions (TM) versus telephone counseling (TC) to promote smoking cessation among hospitalized smokers in a middle-income country. Seven-day abstinence was measured during follow-up phone calls one month after discharge. The comparative cost of the two interventions considered the cost of calls, time spent on phone calls and sending SMS and cost of the professional involved in the approaches. RESULTS: Past 7-day tobacco abstinence was not statistically different between groups (30.5% in TM group and 26% in TC, p = 0.318). Costs were significantly lower in the TM group (U$9.28 × U$19.45- p < 0,001). Continuous abstinence was reported by 26% of TM participants and 24.5% of TC participants (p = 0.730). In the 3-month follow-up, 7-day abstinence was 23% in the TMI and 27% in the TC (p = 0.356) group. Continuous abstinence was reported by 20% of TM participants and 24% of TC participants (p = 0.334). TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03237949 Registred on: 30th May 2017.

Association between tobacco and alcohol use among hospital inpatients / Associação do uso de álcool e tabaco entre pacientes hospitalizados

We aimed to evaluate concurrent use of alcohol and tobacco among hospitalized patients as well as to compare the use of both substances among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and those with other diagnoses. A cross-sectional study took place in a hospital in Minas Gerais (Brazil). Structured surveys were used to evaluate tobacco and alcohol use. Data analysis was conducted using descriptive statistics and chi-square test. We interviewed 972 patients, in which 20.3% were hazardous drinkers and 14.9% tobacco users. Almost half of the smokers (47.6%) were hazardous drinkers, while 15.5% of nonsmokers engaged in harmful consumption of alcohol (p < 0.001). Tobacco use was higher among people living with Human Immunodeficiency Virus when compared with patients that did not have an Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome diagnosis (32.1% vs 14.4%, p = 0.009). Our findings showed the association of tobacco use and hazardous drinking among hospitalized patients in Brazil and a higher prevalence of tobacco use among patients living with Human Immunodeficiency Virus. These findings can be used to develop smoking cessation interventions that address the comorbidities associated with substance use.

O presente estudo teve como objetivo avaliar a associação do uso de álcool e tabaco entre pacientes internados em um hospital geral e comparar o uso das duas substâncias entre pacientes que vivem com o Vírus da Imunodeficiência Humana/Síndrome de Imunodeficiência Adquirida e outros diagnósticos. Realizou-se um estudo observacional em um hospital público para avaliação do uso de tais substâncias. Entre 972 pacientes, 20,3% fizeram uso prejudicial de álcool e 14,9% de tabaco. Quase metade dos tabagistas (47,6%) fizeram uso prejudicial do álcool, enquanto 15,5% dos não tabagistas relataram uso excessivo da substância (p < 0,001). A porcentagem de fumantes foi significativamente mais alta no grupo de pacientes que vivem com o Virus da Imunodeficiência Humana do que nos demais diagnósticos (32,1% vs 14,4%, p = 0,009). Percebe-se a associação do uso de tabaco e uso prejudicial de álcool entre pacientes hospitalizados e alta prevalência do uso de tabaco entre pacientes que vivem com o Vírus da Imunodeficiência Humana/Síndrome de Imunodeficiência Adquirida. Esses dados podem direcionar o planejamento de intervenções para cessação do consumo de tabaco que consigam direcionar as comorbidades relacionadas ao uso da substância

Prevalence of smoking, quit attempts and access to cessation treatment among adults with mental illness in Brazil: a cross-sectional analysis of a National Health Survey.

OBJECTIVES: Determine the national prevalence of smoking and factors related to smoking among adults with mental illness (PLWMI; people living with mental illness) in Brazil. DESIGN: Cross-sectional study. SETTING: We used data from the nationally representative general health survey Pesquisa Nacional de Saude of 2013, which included the Global Adult Tobacco Survey (GATS) module. PARTICIPANTS: The survey used a complex probabilistic sample to collect data from 60 202 Brazilians 18 years or older. Primary and secondary outcomes: smoking prevalence and access to smoking cessation treatment. We also assessed past tobacco use, quit attempts and quit ratio among people with and without mental illness. Analyses were conducted in R and were weighted to account for the survey design and generate national estimates. RESULTS: In Brazil, the 2013 smoking prevalence among PLWMI was 28.4% and among people with no mental illness was 12.8%. Both groups had high rates of past-year quit attempts (51.6% vs 55.3%) but the lifetime quit ratio among PLWMI was much lower than those with no mental illness (37% vs 54%). Adjusted odds showed PLWMI were more likely to be current smokers (OR (95% CI)=2.60 (2.40 to 2.82), less likely to be former smokers (OR (95% CI)=0.62 (0.55 to 0.70)) and as likely to have tried to quit in the past year (OR (95% CI)=0.90 (0.78 to 1.02)). Very few (3.7%) PLWMI and fewer with no mental illness (2.6%) received cessation treatment. CONCLUSION: Smoking rates among PLWMI are roughly double the rate in the general population. Compared with Brazilian smokers without mental illness, those with mental illness were significantly less likely to quit even though as many tried to. Few Brazilians appear to be using publicly available cessation services. Expanding utilisation of treatment might be a good place to start for Brazil to further decrease the prevalence of smoking among PLWMI.

An Experimental Feasibility Study of a Hybrid Telephone Counseling/Text Messaging Intervention for Post-Discharge Cessation Support Among Hospitalized Smokers in Brazil.

OBJECTIVE: Text messaging interventions are effective. Despite high utilization of smartphones, few studies evaluate text messaging for cessation in middle-/lower-income countries. Initiating tobacco treatment in hospitals is an effective but underutilized approach for reaching smokers. We evaluated a hybrid phone counseling/text messaging intervention for supporting cessation among hospitalized smokers in Brazil. METHODS: We used an experimental design to assess the feasibility and potential effect size of the intervention. Participants (N = 66) were recruited from a university hospital and randomized in a 2:1 ratio into TXT (one session of telephone counseling plus 2 weeks of text messaging; N = 44) or Standard Care control group (N = 22). Participants lost to follow-up were counted as smokers. RESULTS: Counselors sent 1186 texts, of which 924 (77.9%) were received by study participants. Participants rated the TXT content as "helpful" (80.4%) and the phone counseling length to be "just right" (95.1%). Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence in the TXT compared to control group at both 1-month follow-up (25.0% vs. 9.1%) and 3-month follow-up (31.8% vs. 9.1%). Carbon monoxide-verified abstinence at month 3 was also higher in TXT (20.5% vs. 4.5%). CONCLUSIONS: This hybrid telephone/text intervention should progress to full-scale effectiveness testing as it achieved favorable outcomes, was acceptable to participants, and was readily implemented. This type of intervention has strong potential for expanding the reach of hospital-initiated tobacco treatment in middle-/lower-income countries. IMPLICATIONS: This study extends research on hospital-initiated smoking cessation by establishing the feasibility of a novel text-messaging approach for post-discharge follow-up. Text messaging is a low-cost alternative to proactive telephone counseling that could help overcome resource barriers in middle- and lower-income countries. This hybrid texting/counseling intervention identified smokers in hospitals, established rapport through a single telephone follow-up, and expanded acceptability and reach of later support by using text-messaging, which is free of charge in this and other low-income countries. The favorable cessation outcomes achieved by the hybrid intervention provide support for a fully powered effectiveness trial.

O ecomapa como ferramenta na formação para o trabalho em rede no campo de álcool e outras drogas / Ecomap as a tool in training for network care in the field of alcohol and other drugs / El ecomapa como una herramienta en la formación de redes en el ámbito del alcohol y otras drogas

O presente artigo visa demonstrar o potencial do Ecomapa como ferramenta/instrumento no processo de formação para o trabalho em rede sobre a temática do uso de drogas. A partir disso, será apresentado um relato de experiência sobre a utilização do Ecomapa em um processo formativo para profissionais da saúde, assistência social e educação, como instrumento de identificação, mapeamento da rede de atenção aos usuários de drogas e fortalecimento do trabalho. Dessa forma, aponta-se o método e os resultados do uso do Ecomapa na formação do trabalho em rede na área de álcool e outras drogas, podendo ser utilizado não somente na prevenção e tratamento, possibilitando reflexões e uma formação contextualizada para o fortalecimento da articulação entre os serviços, integralidade do cuidado e trabalho em rede.

This article aims to demonstrate the potential of Ecomap as an instrument/tool in the training process for networking on the topic of drug use. An experience report will be presented on the use of Ecomap in a training process for health, social care and education professionals, as a resource of identification, mapping and strengthening of the care network. The method and results of Ecomap's use in training processes in the area of alcohol and other drugs are pointed out. Ecomap's use is not restricted to prevention and care, enabling reflection and contextualized formation to strengthen the coordination among services, comprehensiveness care and networking.

En este artículo se pretende demostrar el potencial de Ecomapa como herramienta en el proceso de formación para el trabajo en red sobre el tema del consumo de drogas. Un relato de experiencia será presentado sobre el uso de Ecomapa en un proceso de formación de los profesionales de la salud, asistencia social y educación, como un dispositivo de identificación, asignación de la red de atención y fortalecimiento del trabajo. Para esto, son señalados el método y los resultados del uso de Ecomapa en la formación para el trabajo en redes en el área de alcohol y otras drogas, pudiendo no solo ser utilizado en la prevención y tratamiento, lo que permite la reflexión y la formación contextualizada para fortalecer la coordinación entre los servicios, la integridad de atención y el trabajo en red.

Capacitação em álcool e outras drogas para profissionais da saúde e assistência social: relato de experiência / Training on alcohol and other drugs for health and social care professionals: report on experience / Capacitación sobre alcohol y otras drogas para profesionales de la salud y asistencia social: relato de experiencia

Como alternativa ao panorama deficitário de formação profissional para atuação na área do uso de álcool e outras drogas, e visando à incorporação de mudanças práticas, são criados os Centros Regionais de Referência sobre Drogas (CRRs). Faz-se necessário compreender e refletir sobre o papel dos CRRs nos cenários de formação e atuação sobre a temática. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitação de profissionais do Sistema Único de Saúde e Assistência Social, por meio do relato de experiência de um CRR de Minas Gerais. A implantação do presente CRR possibilitou a qualificação de profissionais em direção a abordagens integrais e reflexivas sobre a temática. Contudo, são necessárias reformulações sobre o seu modelo, com uma posição mais bem definida e atuante dentro das políticas sobre drogas, garantindo continuidade nas ações e auxiliando na reformulação das práticas.

As an alternative to the deficient área of professional education for working on alcohol and other drug use in Brazil, and in order to incorporate changes in practices, Regional Reference Centers for Drugs (CRRs) have been created. Therefore, it is necessary to understand and reflect on the role of CRRs within the scenario of education and action in this field. This paper aimed to discuss aspects of the education process for professionals in the Brazilian Health System and Social Assistance System, through a report on experience from a CRR in the state of Minas Gerais, Brazil. The implementation of this CRR enabled education for professionals towards comprehensive and reflective approaches in this field. However, reformulations of the CRR model are needed, with a better-defined and more active position within drug policies, so a to ensure continuity of actions and aid in reformulation of practices.

Como alternativa al panorama deficitario de formación profesional para la actuación en el área del uso de alcohol y de otras drogas y con el objetivo de la incorporación de cambios prácticos, se crearon los Centros Regionales de Referencia sobre Drogas (CRRs). Por lo tanto, resulta necesario comprender y reflexionar sobre el papel de los CRRs en los escenarios de formación y actuación sobre la temática. A partir de esa base, este artículo tiene el objetivo de discutir aspectos sobre la capacitación de profesionales de los Sistemas Únicos de Salud y de Asistencia Social, por medio del relato de experiencia de un CRR del estado de Minas Gerais. La implantación del presente CRR posibilitó la calificación de profesionales en dirección para abordajes integrales y reflexivos sobre la temática. No obstante, son necesarias reformulaciones sobre su modelo, con una posición mejor definida y actuante dentro de las políticas sobre drogas, asegurando continuidad en las acciones y auxiliando en la reformulación de las prácticas.

[A methodology to implement preventive actions against harmful drug use in the context of primary health care in Latin America]. / Metodologia de implementação de práticas preventivas ao uso de drogas na atenção primária latino-americana.

OBJECTIVE: To develop a methodology to implement practices of prevention against the use of alcohol and other drugs in the context of primary health care (PHC) that will contribute to the debate about policies and actions in Latin American countries. METHODS: This intervention research project was carried out in a small/medium-sized Brazilian city. The development process was assessed through participant observation with the aim of adapting the methodology to local needs and identifying existing weaknesses and strengths with impact on implementation. RESULTS: A model was developed with six stages: initial contact and planning, diagnosis and mapping, sensitization, training, follow-up, and communication of results to participants. The following weaknesses were identified: limitation of resources (human, financial, infrastructural), limitations in the coverage and comprehensiveness of the assistance network, poor participation from physicians, training based on medicalized care, insufficient participation of health care management, insufficient involvement and participation of civil society, and few opportunities for participation of the population in the planning and execution of public policies. Strengths included the participation of community health agents and nurses in applying, organizing, and planning initiatives, in addition to the organization of educative and preventive actions in schools and communities by health care teams, suggesting that it is possible to implement screening, brief intervention, and referral to treatment (SBIRT) initiatives in the context of PHC in Latin America. CONCLUSIONS: The methodology developed in this study can be useful for Latin American countries if local needs are taken into consideration. It should be noted, however, that results will only be observed in the mid- to long term, rather than strictly in the short term.

Metodologia de implementação de práticas preventivas ao uso de drogas na atenção primária latino-americana / A methodology to implement preventive actions against harmful drug use in the context of primary health care in Latin America

OBJETIVO: Desenvolver uma metodologia para implementação de práticas de prevenção ao uso de álcool e outras drogas no âmbito da atenção primária à saúde (APS) que contribua com o debate sobre ações e políticas nos países latino-americanos. MÉTODOS: Trata-se de uma pesquisa-intervenção realizada em um município brasileiro de pequeno/médio porte. O processo foi avaliado através da observação participante, visando adequação às necessidades locais e ressaltando pontos de facilitação e dificuldade na implantação. RESULTADOS: Foi desenvolvido um modelo com seis etapas: contato inicial e planejamento, diagnóstico e mapeamento, sensibilização, capacitação, acompanhamento e devolutiva. Foram percebidos os seguintes pontos de dificuldade: insuficiência de recursos (humanos, financeiros, infraestrutura), falta de integralidade e intersetorialidade da rede assistencial, falta de participação dos médicos, formação calcada no saber médico, participação insuficiente da gestão de saúde, falta de mobilização e participação da sociedade civil, ausência de momentos onde a população fosse convidada a participar do planejamento e execução das políticas públicas. Pontos fortes foram: participação dos agentes comunitários e enfermeiros na aplicação, organização e planejamento das práticas, além da realização de práticas educacionais e preventivas nas escolas e comunidades pelas equipes de saúde. Isso indica que é possível implementar iniciativas de triagem, intervenção breve e encaminhamento para tratar (SBIRT) no contexto da APS latino-americana. CONCLUSÕES: A metodologia desenvolvida neste estudo pode ser útil para países latino-americanos desde que sejam consideradas as necessidades locais. Entretanto, os resultados serão observados apenas a médio e longo prazo, sem mudanças instantâneas.

OBJECTIVE: To develop a methodology to implement practices of prevention against the use of alcohol and other drugs in the context of primary health care (PHC) that will contribute to the debate about policies and actions in Latin American countries. METHODS: This intervention research project was carried out in a small/medium-sized Brazilian city. The development process was assessed through participant observation with the aim of adapting the methodology to local needs and identifying existing weaknesses and strengths with impact on implementation. RESULTS: A model was developed with six stages: initial contact and planning, diagnosis and mapping, sensitization, training, follow-up, and communication of results to participants. The following weaknesses were identified: limitation of resources (human, financial, infrastructural), limitations in the coverage and comprehensiveness of the assistance network, poor participation from physicians, training based on medicalized care, insufficient participation of health care management, insufficient involvement and participation of civil society, and few opportunities for participation of the population in the planning and execution of public policies. Strengths included the participation of community health agents and nurses in applying, organizing, and planning initiatives, in addition to the organization of educative and preventive actions in schools and communities by health care teams, suggesting that it is possible to implement screening, brief intervention, and referral to treatment (SBIRT) initiatives in the context of PHC in Latin America. CONCLUSIONS: The methodology developed in this study can be useful for Latin American countries if local needs are taken into consideration. It should be noted, however, that results will only be observed in the mid- to long term, rather than strictly in the short term.

Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice.

BACKGROUND: Numerous studies have demonstrated that positive organizational climates contribute to better work performance. Screening and brief intervention (SBI) for alcohol, tobacco, and other drug use has the potential to reach a broad population of hazardous drug users but has not yet been widely adopted in Brazil's health care system. We surveyed 149 primary health care professionals in 30 clinics in Brazil who were trained to conduct SBI among their patients. We prospectively measured how often they delivered SBI to evaluate the association between organizational climate and adoption/performance of SBI. METHODS: Organizational climate was measured by the 2009 Organizational Climate Scale for Health Organizations, a scale validated in Brazil that assesses leadership, professional development, team spirit, relationship with the community, safety, strategy, and remuneration. Performance of SBI was measured prospectively by weekly assessments during the three months following training. We also assessed self-reported SBI and self-efficacy for performing SBI at three months post-training. We used inferential statistics to depict and test for the significance of associations. RESULTS: Teams with better organizational climates implemented SBI more frequently. Organizational climate factors most closely associated with SBI implementation included professional development and relationship with the community. The dimensions of leadership and remuneration were also significantly associated with SBI. CONCLUSIONS: Organizational climate may influence implementation of SBI and ultimately may affect the ability of organizations to identify and address drug use.

Clima organizacional e atividades de prevenção ao uso de risco de álcool / Organizational climate and alcohol risk prevention

O objetivo deste estudo foi avaliar a associação entre Clima Organizacional e atividades de prevenção ao consumo de álcool entre 97 profissionais da Atenção Primária à Saúde. O clima organizacional foi avaliado por meio de escala envolvendo os seguintes fatores: tomada de decisão, caos/stress e comunicação. As atividades de prevenção foram mensuradas a partir do número de Alcohol Use Disorders Identification Tests (instrumento de rastreamento) e de intervenções breves realizados no período de 6 meses após a capacitação presencial. Para verificar a existência das associações utilizou-se a correlação não paramétrica de Spearman, com 95 por cento de intervalo de confiança. O número de intervenções breves realizadas relacionou-se com Tomada de Decisão (p=0,337; p=0,001) e Comunicação (p=0,281; p=0,005), enquanto o número de Alcohol Use Disorders Identification Tests aplicados associou-se com Tomada de Decisão (p=0,288; p=0,004) e Comunicação (p=0,215; p=0,035). Os resultados sugerem que ambientes com melhor percepção do clima organizacional podem ser facilitadores para a prevenção do uso de álcool na Atenção Primária à Saúde.(AU)

The aim of this paper was to evaluate the link between organizational climate and strategies to prevent alcohol consumption, among 97 Primary Health Care professionals. The organizational climate was measured by means of a scale involving the following factors: decision-making, chaos/stress and communication. Prevention activities were measured using AUDIT (screening test) and brief interventions carried out in the six-month period following the on-site qualification. The Spearman test was used, with a 95 percent level of confidence, to assess correlation. The results showed a correlation between brief intervention and Decision Making (p=0.337; p= 0.001) and Communication (p=0.281; p=0.005). The number of AUDITs applied were also related to DM (p=0.288; p=0.004) and Communication (p=0.215; p=0.035). The results suggest that environments with better perceptions of Organizational Climate can enhance the prevention of alcohol use in Primary Health Care.(AU)

Clima organizacional e atividades de prevenção ao uso de risco de álcool / Organizational climate and alcohol risk prevention

O objetivo deste estudo foi avaliar a associação entre Clima Organizacional e atividades de prevenção ao consumo de álcool entre 97 profissionais da Atenção Primária à Saúde. O clima organizacional foi avaliado por meio de escala envolvendo os seguintes fatores: tomada de decisão, caos/stress e comunicação. As atividades de prevenção foram mensuradas a partir do número de Alcohol Use Disorders Identification Tests (instrumento de rastreamento) e de intervenções breves realizados no período de 6 meses após a capacitação presencial. Para verificar a existência das associações utilizou-se a correlação não paramétrica de Spearman, com 95 por cento de intervalo de confiança. O número de intervenções breves realizadas relacionou-se com Tomada de Decisão (p=0,337; p=0,001) e Comunicação (p=0,281; p=0,005), enquanto o número de Alcohol Use Disorders Identification Tests aplicados associou-se com Tomada de Decisão (p=0,288; p=0,004) e Comunicação (p=0,215; p=0,035). Os resultados sugerem que ambientes com melhor percepção do clima organizacional podem ser facilitadores para a prevenção do uso de álcool na Atenção Primária à Saúde.

The aim of this paper was to evaluate the link between organizational climate and strategies to prevent alcohol consumption, among 97 Primary Health Care professionals. The organizational climate was measured by means of a scale involving the following factors: decision-making, chaos/stress and communication. Prevention activities were measured using AUDIT (screening test) and brief interventions carried out in the six-month period following the on-site qualification. The Spearman test was used, with a 95 percent level of confidence, to assess correlation. The results showed a correlation between brief intervention and Decision Making (p=0.337; p= 0.001) and Communication (p=0.281; p=0.005). The number of AUDITs applied were also related to DM (p=0.288; p=0.004) and Communication (p=0.215; p=0.035). The results suggest that environments with better perceptions of Organizational Climate can enhance the prevention of alcohol use in Primary Health Care.