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Health is a major area of focus for the Narotam Sekhsaria Foundation and it supports health interventions across various healthcare settings. The Foundation has also supported several projects in cancer prevention and care, right from its inception. As an extension of this support, a tobacco treatment service called LifeFirst was initiated in 2013, with the objective of helping people overcome their dependence on tobacco.
The Burden of Tobacco in India
According to the Global Adult Tobacco Survey, India is home to 275 million current tobacco users.
This equates to 48% of Indian men over age 15 being current tobacco users, of which 24% of men are smokers and 33% are smokeless tobacco users.
Among Indian women over age 15 years, 18% are smokeless tobacco users and 3% are smokers
Source: Giovino GA, Mirza SA, Samet JM, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative
cross sectional household surveys. Lancet. Aug 2012; 380(9842):668-679.
Need for Cessation Services
Nearly half of the current smokers (47%) and smokeless tobacco users (46%) want to quit their tobacco use (GATS 09-10)
Nearly 2 out of every 5 smokers have attempted to quit (GATS 09-10)
Among those who visited a health facility, less than half (46%) of smokers and less than one-third (27%) of smokeless tobacco users were advised by health care professionals to quit tobacco. (GATS 09-10)
Challenges and Opportunities
High prevalence of smokeless tobacco use
Need to adapt the evidence on tobacco cessation to the specific conditions of tobacco use in India
Tobacco cessation medication is not affordable for most, but counseling may have a bigger effect than in the West
Importance of family and social role
LifeFirst is a Tobacco Treatment Service that has been created to catalyse, build capacity and establish a high quality, proven tobacco cessation service. It is built upon international evidence base, standards and protocols (from Massachusetts General Hospital’s Tobacco Treatment Service, Ottawa Model, Canada and National Health Service, UK) and adapted to the Indian context. The service aims to deliver a comprehensive, evidence based tobacco treatment for patients from all social strata.
Components:
1. Service delivery 2. Training – Service providers, tobacco free sites 3. Research – Monitoring and evaluation, allied research
Ottawa Model for Smoking
Cessation- Concepts referred
OMSC in primary care
Ottawa Model’s components
Ottawa Model Implementation Plan
Ottawa Model for Smoking Cessation Program
Management Database
Ottawa Model for Smoking
Cessation- Concepts referred
ASK AND DOCUMENT -Include tobacco use question as one of the patient’s vital signs.
ADVISE AND REFER - Provide strong, personalized, non-judgmental advice to quit
ACT – For Patient who is READY TO QUIT: QUIT PLAN VISIT Strategic counseling Pharmacotherapy, Follow-up/Smokers’ Helpline
For Patient who is NOT READY TO QUIT: • Follow-up/Smokers’ Helpline
ASK AND DOCUMENT –Screening of OPD patients by counselor
ADVISE AND REFER - Provide strong, personalized, non-judgmental advice to quit by counselor
ACT – Intensive counseling and follow-up support(face-to-face/phone) for 6 months For Patient who is NOT READY TO QUIT: Motivational interviewing and 5R’s
Constraints in adaptation
Pharmacotherapy
Limited evidence in smokeless use
Availability and affordability
No dedicated Quitline for tobacco cessation
Ottawa Model Implementation Plan
Phase 1 - Program Introduction
Phase 2 - Baseline Assessment
Phase 3 - Planning Clinic Tobacco Control Protocol
Phase 4 - Training
Phase 5 - Program Implementation (“Go Live” Date)
Phase 6 - Post-Assessment and Ongoing Quality
Improvement
Phase 7 - Sustaining the Program
Phase 1 - Program Introduction
Meetings with the Municipal Commissioner and Medical Officer – Health
Meetings with Family Welfare Officer
Joint meetings with Family Welfare Officer, Medical officers and staff at the two Urban Health Posts
Phase 2 - Baseline Assessment
Baseline study to know-
prevalence of tobacco use among OPD patients
knowledge of health effects related to tobacco among patients
Intention to make quit attempts
Past quit attempts
Willingness to enroll in a cessation service provided through the urban health post
Phase 4 - Training
Training of counselor by Mayo Trained TTS
Trained tobacco cessation counselor to provide intensive cessation counseling to OPD patients
1 day training for doctors, nurses and other health post and outreach staff in providing brief advice and referral to the counselor
Phase 5 - Program Implementation
(“Go Live” Date)
LifeFirst cessation service launched in the presence of officials form the Municipal Corporation
Phase 6 - Post-Assessment and
Ongoing Quality Improvement
Monitoring visits by the core team
Monthly reporting on set indicators
Ongoing training to counselor
Phase 7 - Sustaining the Program
Yearly reporting to the Navi Mumbai Municipal Corporation
Meetings with the Medical Officers to share performance and program outcomes on a periodic basis
Results: 2 years report
Patients enrolled so far- 458
Patients completed 6 follow-ups- 266
Self-reported 7-day PPA among patients completed 6 months (including loss to follow-up)- 26%
LifeFirst E-App
LifeFirst team developed an Android based E-app to manage patient data and provide counseling effectively.
Based on the 5A’s approach.
Based on Ottawa Model for Smoking Cessation Program Management Database
Ask- Screening patients
TTS asks all admitted patients about their tobacco use (showing images of locally used tobacco products).
Real-time data on patients’ tobacco use is entered into the E-App, and later used for counseling and follow-ups.
Advice- Provide Brief Advice
Videos and images on health effects of tobacco, benefits of quitting and association of tobacco use with current diagnosis is shown.
Assessing willingness to quit
For patients willing to quit TTS contacts patients for a detailed 1st session based on the patient’s stage of readiness to quit i.e. 1 month (preparation stage) or 6 months (contemplation stage)
For patients not willing to quit- Using 5R’s techniques with the help of multimedia(videos and images)
Assist in providing counseling
For patients willing to quit, an electronic referral is made and an appointment is allotted. An SMS reminder is sent to the patient a day prior to the appointment and creates a list of appointments for the TTS.
Arrange
System gives prompts on patients due follow-ups at set intervals(7 day, 15 day, 1 month etc.).
Counselor can access data collected during the detailed session and use information during follow-ups.
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