Training healthcare providers to deliver evidence-based brief interventions for tobacco use and dependence

Tobacco use is the leading cause of preventable death and disease in the U.S. with cessation causing major health benefits. Healthcare providers are vital to the delivery of tobacco cessation services. The evidence-based Public Health Service (PHS) Clinical Practice Guideline for the Treatment of Tobacco Use and Dependence (Fiore, 2000) provides recommendations that can be implemented with minimal demands on providers, can increase patient quit rates, are cost-effective, and should be part of the routine care of every patient at every visit; however, healthcare providers are poor at implementation. Providers report a number of barriers, including lack of knowledge, awareness, self-efficacy, and positive outcome expectancies. In Arkansas, a training program was developed to address these barriers. From 1-2006 to 1-2007, 807 providers completed a 1-hour CE-approved training delivered by doctoral-level faculty. Tests were administered prior to and immediately after training with responses reported on a scale of 0-10 with 0 =“None” and 10 = “Most Ever.” Paired-samples t-tests compared pre- and post-test responses. Training resulted in significant increases in factors known the affect intervention performance including a) motivation, b) knowledge, and c) confidence, as well as perceived d) importance, e) effectiveness, f) importance of barriers, and g) preparedness (all p.s <.01). Because tobacco use is the most deadly and the costliest public health problem in the U.S. and this very brief training is likely to increase the frequency with which patients are offered assistance with cessation, this minimal 1-hour training should be broadly disseminated among all healthcare providers.