Clinician perceptions of factors influencing referrals to a smoking cessation program

<p>Abstract</p> <p>Background</p> <p>Referral of patients to smoking cessation telephone counseling (i.e., quitline) is an underutilized resource by primary care physicians. Previously, we conducted a randomized trial to determine the effectiveness of benchmarked feedback on clinician referrals to a quitline. Subsequently, we sought to understand the successful practices used by the high-referring clinicians, and the perceptions of the barriers of referring patients to a quitline among both high and non-referring clinicians in the trial.</p> <p>Methods</p> <p>We conducted a qualitative sub-study with subjects from the randomized trial, comparing high- and non-referring clinicians. Structured interviews were conducted and two investigators employed a thematic analysis of the transcribed data. Themes and included categories were organized into a thematic framework to represent the main response sets.</p> <p>Results</p> <p>As compared to non-referring clinicians, high-referring clinicians more often reported use of the quitline as a primary source of referral, an appreciation of the quitline as an additional resource, reduced barriers to use of the quitline referral process, and a greater personal motivation related to tobacco cessation. Time and competing demands were critical barriers to initiating smoking cessation treatment with patients for all clinicians. Clinicians reported that having one referral source, a referral coordinator, and reimbursement for tobacco counseling (as a billable code) would aid referral.</p> <p>Conclusion</p> <p>Further research is needed to test the effectiveness of new approaches in improving the connection of patients with smoking cessation resources.</p> <p>Trial Registration Number</p> <p>Clinicaltrials.gov NCT00529256</p

Reaction of preschool children to the birth of a sibling

The experience of becoming and having a sibling is a common situation for many preschool children. In order to clarify the implications of such an event for the older preschool child, the authors have surveyed the literature and interviewed a series of families where there was a second or third birth. This is a preliminary communication where a broad overview of the many variables involved is sought. Varied techniques for preparing the older preschool sibling were observed, as were varied coping mechanisms employed by the older child in adjusting to the change in his family status. Fourteen variables are discussed, and suggestions are made for further research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43963/1/10578_2005_Article_BF01441311.pd

RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population

Background: Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population.Methods/Design: A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up.Discussion: This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.<br /

Nature’s nations: the shared conservation history of Canada and the USA

Historians often study the history of conservation within the confines of national borders, concentrating on the bureaucratic and political manifestations of policy within individual governments. Even studies of the popular expression of conservationist ideas are generally limited to the national or sub-national (province, state, etc.) scale. This paper suggests that conservationist discourse, policy and practice in Canada and the USA were the products of a significant cross-border movement of ideas and initiatives derived from common European sources. In addition, the historical development of common approaches to conservation in North America suggests, contrary to common assumptions, that Canada did not always lag behind the USA in terms of policy innovation. The basic tenets of conservation (i.e. state control over resource, class-based disdain for subsistence hunters and utilitarian approaches to resource management) have instead developed at similar time periods and along parallel ideological paths in Canada and the USA

Patient Participation in Research in the Managed Care Environment: Key Perceptions of Members in an HMO

This study's objective was to elicit the views of research among enrollees in an HMO. A questionnaire was mailed to 207 adult enrollees, 55% had been exposed to research and 45% had not. Ninety-four percent of respondents supported research within the HMO, and 87% thought using information from medical records for research was acceptable. Sixty-three percent thought participation in research increased patient understanding of health care. Significantly more prior research participants thought that participation in research improves care. More patients would participate if written information were provided (67%), if feedback of results was provided (72%), and if their clinician invited them (67%). Only a modest percentage (20%) of patients would participate in a randomized trial