Implementing Clinical Tobacco Intervention for 10 Canadian Campus Clinics

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Implementing Clinical Tobacco Intervention
for 10 Canadian Campus Clinics

• Sharon Lawler, RN, MEd
• Manager Co-Director Leave The Pack Behind
• Melodie Shick-Porter, RN, BA (Comm.Nurs.)
• Director of Clinical Services, Brock University
• Co-Director Leave The Pack Behind
• Kelli-an Lawrance, PhD
• Associate Professor, Brock University
• PI Co-Director Leave The Pack Behind
• Peter Selby, MBBS CCFP MHSc
• Assistant Professor, University of Toronto
• Director, Addictions Services, Centre for
  Addiction Mental Health
• Medical Consultant to Leave The Pack Behind

with funding from Health Canada the Government
of Ontario
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Leave The Pack Behind
Student Health Clinic Services prevention
cessation through supportive organizational
structures, health professional
interventions
Tobacco Control Programming
denormalization prevention, protection
cessation through peer-to-peer
communication campaigns
programs
LTPB
Research Program Evaluation related to
student tobacco use reach effectiveness
of interventions
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Leave The Pack Behind
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Campus-based CTI

• That each clinic will
• use the Ask-Advise-Assist-Refer model
• set up a chart cueing system
• hand out LTPB cessation materials
• sustain the practice over time

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Barriers to Campus Clinic CTI

• 1 Time patient volume
• 2 Self-efficacy of staff
• 3 Staff turnover
• 4 Remuneration
• 5 Walk-in nature of clinic

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LTPB-CTI Training Strategies

• Recruitment
• - Incentive dinner/lunch meetings
• - CME credits
• - Usual educational time and place
• - Peer expert presenter
• Adult learning format
• - Small group (individual clinic)
• - Identify educational needs of individuals
• - Slides case studies open forum
• - Information packages

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Typical Clinician Needs

• Why talk to smokers?
• How to talk to regular and social smokers
• How best to use pharmaceutical options
• How to move smokers toward quitting
• How to integrate CTI into their clinic

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Training Content
Typical Clinician Needs

• Convince physicians/ nurses of importance of
  asking all students about smoking
• Equip with new skills and knowledge
• Familiarize with cessation materials referral
  options
• Analyze their own clinic and how to introduce CTI
  system
• Brainstorm on solutions to barriers

• Why talk to smokers
• How to talk to regular and social smokers
• How best to use pharmaceutical options?
• How to move smokers toward quitting
• How to integrate CTI into their clinic?

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Typical Stages of Change for Young Adults
Age ______ 15 19 20 24
Population Estimate _______ 543,000 878,000
Precon- templation ______ 31 30
Contem- plation ______ 36 30
Preparation ______ 17 14
Action ______ 5 7
Main- tenance ______ 11 20
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Time Accommodation

• Question for 30-second intervention
• Ask
• Advise offer return visit
• Question for 1-minute intervention
• Ask
• Advise
• Refer for return visit or Peer Support service
• Question for 10-minute intervention
• Ask
• Advise
• Assess
• Assist

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4 Key Questions

• Do you use tobacco? Even a puff?
• On a scale of 1 to 10, how important is it to you
  to quit?
• On a scale of 1 to 10, how confident are you that
  you can quit?
• Would you like help?

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Clinic System

• Poster and cessation materials in waiting room
  and examining rooms
• LTPB clinic package in examining rooms
• CO monitor availability
• Chart cueing system
• Referral information for Peer Support

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Evaluating readiness of clinic to implement CTI

• Use importance/confidence question
• Situational analysis
• Easy wins
• Change is a process
• Pay attention to the politics (e.g., new campus
  policies, local by-laws)

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Sustainability

• Influencer on staff
• Inter-campus clinic support
• Cessation materials monitored
• Regular follow-up support from LTPB
• Feedback of success periodic additional training

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Outcomes

• 10 campus clinics with CTI activities
• System in place to monitor cessation material
  dissemination through clinics
• Key contacts in all 10 clinics
• Partnership with LTPB and 10 clinics
• Sustained recruitment to clinic cessation services