This activity is designed to change: Competence, Performance.4hr(s)
Activity Format:

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Overview

Goal: Physicians will screen patients for tobacco use and conduct tobacco cessation interventions utilizing best practice guidelines and motivational interviewing techniques.

Professional Practice GapsAlmost 75% of smokers recently surveyed reported an interest in quitting (Gallup, 2010). Primary care physicians have a golden opportunity to intervene with tobacco using patients, yet screening and intervention rates remain low (Seale et al, 2010). Despite the opportunity, patient interest, and evidence of treatment effectiveness, physicians still are not fully implementing guidelines in their practices and need conduct screening and intervention more consistently and thoroughly.
Newport F. Gallup Poll: Most U.S. Smokers Want to Quit, Have Tried Multiple Times. Gallup Poll. 2010. Available at: http://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspx?utm_source=2010%20smoking&utm_medium=search&utm_campaign=tiles
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20205740

Educational Objectives:

After completing this activity participants will be able to:
  • Utilize the 5 steps of smoking cessation intervention (the 5 A's) and determine each patient's stage in the tobacco cessation cycle to develop individualized tobacco interventions.

  • Evaluate personal characteristics or needs of individual patients who smoke (e.g., concerns about weight gain, amount smoked, history of failed attempts at quitting smoking, etc.) and use the information to guide interventions.

  • Implement the current recommendations -- including indications and contraindications, special precautions, and warnings --- when prescribing first-line tobacco deterrent pharmacotherapies.

  • Apply motivational interviewing techniques in typical circumstances encountered in primary care with patients who have alcohol, tobacco, or other substance use problems.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.
Mary P Metcalf, PhD, MPH (Vice President, Clinical Tools, Inc.)Mary Metcalf has had an interest in education since she first volunteer for the Insect Zoo at the Smithsonian in 1980. Since then, she has expanded her repertoire to include the development and assessment of medical and science education projects. She completed her undergraduate work at New College of Florida with a double major in Math and Anthropology, and graduate studies at the University of Virginia, in Anthropology. She worked in archaeology for 10 years, and is a Registered Professional Archaeologist. After her work in archaeology began to focus on education, she moved into health and medical education at Clinical Tools, Inc. in Pittsburgh, PA, where she also taught at Carnegie Mellon University from 1996-1998. Since relocating to Chapel Hill, NC, Dr. Metcalf has pursued additional education in public health, with an MPH from UNC-CH, and becoming a Certified Health Education Specialist (CHES). Dr. Metcalf brings her diverse background to Clinical Tools' project by concentrating on adult learning, and qualitative and quantitative assessment. She served as Principal Investigator for 3 SBIR Phase//Phase II projects, leading to EndingSuicide.com, and TobaccoCME.com, as well as BrainTrain4Kids.com. Dr. Metcalf enjoys doing yoga, anything that involves being outdoors, reading F/SF, and drinking black tea. Most of all, she enjoys spending time with her family, which includes three amazing and confusing children, and cleaning up the messes they leave behind.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Carolyn Schlede, MD (Internal Medicine Attending and Director of the Smoking Cessation Clinic James A. Haley Veterans' Hospital, University of South Florida College of Medicine)Dr. Carolyn Schlede is an Attending physician with experience and expertise in smoking cessation. She graduated from Cornell and then received her medical degree from the University of Rochester School of Medicine and Dentistry. She did her residency in Internal Medicine at the University of South Florida. She is certified by the American Board of Internal Medicine and Geriatric Medicine. She has been active in smoking cessation since establishing the Smoking Cessation Clinic at the James A. Haley Veterans' Hospital in 1984. Since that time she has been instrumental in establishing and expanding smoking cessation programs at VA hospitals and clinics throughout Florida and Puerto Rico, as well as many hospitals and clinics in the private sector. She has given numerous Grand Rounds, train-the-trainer workshops, seminars, and other CME programs on smoking cessation throughout the United States. She has been invited to participate in planning committees for tobacco cessation programs for the VA, Department of Defense, American Cancer Society, American Lung Association, and AHEC. Dr. Schlede has presented her research results at national meetings as well as international meetings, including the World Conference on Tobacco or Health.
Disclosure: Has disclosed no relevant financial relationships.
Peter Friedmann, MD (Associate Professor of Medicine and Community Health, Brown Medical School)Dr. Friedmann is a primary care physician, ASAM-certified addictionist, and substance abuse researcher. He is a nationally recognized expert on screening for substance use disorders in medical settings, the organization of care for patients with addictive disorders, and the role of the primary care physician in the diagnosis and treatment of substance problems. He has given several invited presentations on buprenorphine in primary care and on substance abuse treatment in primary care. He is a course director for ASAM's buprenorphine training series, a member of ASAM's Buprenorphine Training Subcommittee and a mentor in the SAMHSA-funded Physician Clinical Support System (www.pcssmentor.org). He is also president-elect for the Association for Medical Education and Research in Substance Abuse (www.amersa.org).
Disclosure: Has disclosed no relevant financial relationships.
Timothy John McGrath, MD, MBA (Family Physician, Private Practice )Dr. McGrath is currently in private practice in Mebane, North Carolina. He earned his undergraduate degree at Drew University and his medical degree at the Medical College of Georgia. He completed his residency at the University of North Carolina at Chapel Hill, where he served as Chief Resident in the Department of Family Medicine. His interests include preventive medicine and disease modifying lifestyles, medical delivery systems, and medical economics. He is currently enrolled in the Kenan Flagler executive master of business administration program at UNC. Dr. McGrath is an active member of the NCAFP, AAFP, and AMA.
Disclosure: Has disclosed no relevant financial relationships.
Ted Diedrich, MSc (SBIRT Progarm Coordinator; PhD Student, Denver Health and Hospital Authority, Denver, CO University of Colorado at Denver)
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:Editorial Review:
Fri, 4/30/2010Fri, 4/30/2010

Modules in this Training Activity

  • Tobacco Cessation

  • Tobacco Cessation Pharmacotherapy

  • Tobacco: Five Cases: Basic Tobacco Cessation Interventions

  • Motivational Interviewing for Primary Care

Module Practice Gap References
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236.
Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioural domains: a systematic review. Addiction. 2001; 96(12): 1725-1742.
Emmons K, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Recognition of alcohol and substance abuse. American Family Physician. 2003; 67(7): 1529-1532,1535-1536.
Report to congress on the prevention and treatment of co-occurring substance abuse disorders and mental disorders. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf. 2005. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf Accessed on: 2007-07-19.
SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. 2014. Available at: http://www.samhsa.gov/sbirt Accessed on: 2015-03-20.
Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000--2004. Morbidity and Mortality Weekly Report (MMWR). 2008; 57(45): 1226–1228. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medicine. 2004; 27(4): 316-322.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, DHHS Publication SMA 09-4434 . 2009. Available at: http://archive.samhsa.gov/data/NSDUH/2k8nsduh/2k8Results.htm Accessed on: 2009-09-10.
Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Smoking. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. 1986.
US Dept of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf Accessed on: 2004-12-17.
US Public Health Service. Treating tobacco use and dependence. Office of the Surgeon General Website. 2008. Available at: http://www.ncbi.nlm.nih.gov/books/NBK63952/ Accessed on: 2010-06-15.

Audience and Accreditation

Audience:

Physicians and other health care providers

TypeEst. TimeReleasedExpires
FBN4.75 hr(s)10/31/1010/31/17

Designation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education by Clinical Tools, Inc.. Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
FBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4.75 hour(s) of FBN credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
A letter of completion for up to 4 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.
Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
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FundingInitial development of this activity was supported by a grant from the National Heart, Lung, and Blood Institute (#R44HL65885).