Cardiology Rx for Change: Improving Clinical Attention to Tobacco Use and Secondhand Smoke Exposure in Cardiology

Abstract

Background: Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology. Hypothesis: We hypothesized that the curriculum would be associated with improvements in clinician tobaccorelated knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up. Methods: The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups. Results: Trainees' tobacco treatment knowledge increased significantly from pre-to post-training (t[81] = 6.51, P < 0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = −3.97, P < 0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P < 0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs. Conclusions: Available online via http://rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care.

Evaluation of a Shared Pharmacogenomics Curriculum for Pharmacy Students

“…Other shared curricula have also resulted in increased self-reported abilities of the trainees for providing counseling to patients. A shared tobacco cessation curriculum showed a positive impact on pharmacy students' self-reported abilities for providing tobacco cessation counseling [18,19] as well as psychiatry and medical residents' ability to advise Shared pharmacogenomics curriculum for pharmacy students Research Article smokers to quit smoking [13,14]. There are intrinsic values associated with a shared curriculum approach, perhaps most importantly it eliminates the need for faculty at all schools of pharmacy to develop lectures, on the same topics, and therefore conserves faculty time.…”

“…For shared curricula in other areas of medicine and/or pharmacy, measurements evaluating student outcome include knowledge, attitudes, confidence and behaviors [12][13][14][15]. Sparse data exist to characterize the impact of pharmacogenomics instruction on student training outcomes [9].…”

The Past, Present, and Future of Nicotine Addiction Therapy

“…In a separate meta-analysis, more intensive provider cessation advice achieved a higher likelihood of quitting when compared to minimal advice (OR = 1.37; 1.20–1.56 CI), and direct comparison suggested a benefit of follow-up visits (46). A number of tobacco-treatment curricula have been developed to enhance providers’ knowledge, skills, and behaviors, with demonstrated increases in provision of cessation treatment (47–49). …”

Secondhand smoke and atrial fibrillation: Data from the Health eHeart Study

“…8 It is estimated that SHS exposure increases nonsmokers’ coronary artery disease (CAD) risk by 25% to 30%, 9 and the vast majority of deaths in the United States attributed to SHS are from heart disease. 10 Protection from SHS through the implementation of smoke-free legislation is rapidly followed by reductions in hospital admissions for acute myocardial infarctions, stroke, and other cardiac events. 11–13 Despite progress in reducing smoking prevalence and the resultant SHS exposure, SHS remains a significant hazard in the U.S. and worldwide.…”