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TOBACCO CESSATIION GUIDELINES FOR HIGH RISK GROUPS [TOB-G] [664292] - Project
Project abstract

TOB-G project aims to develop and implement an innovative and cost effective approach to prevent chronic diseases related to tobacco dependence. The specialized guidelines for high risks groups will be developed according to ENSP’s evidence based and good practices in tobacco cessation and with ERS TCC scientific material on smoking health hazards. High risk populations are considered those who suffer from cardiovascular diseases, COPD, type 2 diabetes, adolescents & pregnant women.The developed guidelines will contain strategies and recommendations designed to assist health professionals in delivering and supporting effective treatment of dependence on tobacco. Recommendations will be made as a result of scientific reviews and evidence of good practices from scientific groups that will consist of health professionals of different expertise. To monitor the quality of the approach a pilot implementation of the tobacco cessation will be conducting for each group. The assessment of the effectiveness of the tobacco cessation guidelines will be the primary aim of the scientific groups and will be measured by the number of people quitting smoking after the pilot implementation. Since the tobacco cessation guidelines will be addressed to health professionals, the partnership will develop and implement an e-learning training for guidelines use.The project fits perfectly the objectives and priorities of the 3rd Health Programme, as it will assist health professionals to provide guidance and targeted prevention to high risk populations engaged to the unfavourable lifestyle of smoking. Training primary care physicians addresses the lack of specialist doctors in EU and increases access to tobacco cessation specialists. TOB-G project will enhance the overall European capacity in the treatment of tobacco dependence, thus, in the prevention of chronic diseases, through offering smoking cessation tools, appropriately assessed and fitted to the specific needs of high risk groups.

Summary of context, overal objectives, strategic, relevance and contribution of the action

TOB-G project aimed to develop and implement an innovative and cost effective approach to prevent chronic diseases related to tobacco dependence. In order to achieve this aim, specialized smoking cessation guidelines for high risks groups have been developed according to ENSP’s evidence based and good practices in tobacco cessation.
The TOB-G project reaches a variety of target groups: the primary target includes health care professionals and the direct target group concerns high risk populations in Europe who are current tobacco users.
Health care professionals were the primary target since their training can increase access to medical expertise and information regarding to tobacco related health risks and it can overall improve the quality of their services and the healthcare system at a European level. During project implementation, the primary target group, i.e. health professionals from different expertise benefited from the project by obtaining skills that they could use to help stop the tobacco epidemic. More specifically, the primary target group was actively involved in the project through the following activities: piloting the training course sharing knowledge, experience and ideas from different countries of Europe and implementing tobacco cessation guidelines.
Moreover, the TOB-G smoking cessation guidelines were specially constructed based on the following high risk groups, which were the direct target group of the project:
1. Chronic Disease Patients:
- Cardiovascular diseases patients. Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and most CVDs can be prevented by addressing risk factors, such as tobacco use.
- Chronic obstructive pulmonary disease (COPD) patients. Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing – it is more than a “smoker’s cough”- and its primary cause is tobacco smoke. COPD is not curable, but treatment can slow the progress of the disease.
- Adults suffering from Type 2 Diabetes. Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world. It is a key fact that healthy diet, regular physical activity and avoiding tobacco use can prevent or delay the onset of type-2 diabetes.
2. Other Special Groups at high risk for chronic disease development:
- Adolescents. Adolescents who smoke are likely to hinder the growth rate of their lungs are more likely to develop respiratory diseases and are more likely to engage in other risky behaviours.
- Pregnant women. Smoking during pregnancy can severely affect the developing baby, increasing the risks of many conditions including: lower birth weight, fetal growth restriction, miscarriage, preterm delivery, the baby being born with weaker lungs or be vulnerable to respiratory infections.

The project fitted perfectly the objectives and priorities of the 3rd Health Programme, as it assisted health professionals to provide guidance and targeted prevention to high risk populations engaged to the unfavourable lifestyle of smoking. Training primary care physicians can address the lack of specialist doctors in EU and increase access to tobacco cessation specialists. In this context, the TOB-G project enhanced the overall European capacity in the treatment of tobacco dependence, thus, in the prevention of chronic diseases, through offering smoking cessation tools, appropriately assessed and fitted to the specific needs of high risk groups.

The developed guidelines contain strategies and recommendations designed to assist health professionals in delivering and supporting effective treatment of dependence on tobacco. Recommendations are a key part of these guidelines, as a result of scientific reviews and evidence of good practices from scientific groups that consisted of health professionals o

Methods and means

The tobacco cessation guidelines are addressed to health professionals which are the primary target group of the project. These guidelines are now available in both English and French. Each tobacco cessation guideline is addressed to a different high risk group which faces different health risks and needs special treatment. For the development of the specialized tobacco cessation guidelines, the following activities took place: (a) Establishment of five scientific groups consisting of health professionals with different expertise, (b) Every scientific group performed a situation analysis and assessment of each high risk group, (c) Development of the tobacco cessation guidelines for every high risk group and (d) Approval of the guidelines from the project’s steering group committee before the beginning of pilot implementation.
The pilot implementation of the TOB.g guidelines was an important stage of the project, as it provided significant information in order to address the effectiveness and usefulness of the guidelines/intervention and acquire important feedback for further improvement. In detail, a pre-post pilot study was conducted. Two sets of data collection occurred: provider and patient.
For providers, a 1-day training session was conducted. The training session was designed to communicate key recommendations from the TOBG guidelines for patients, pregnant women and adolescents. The intervention focused on understanding and treating the epidemic of tobacco in Europe, including factors that push in tobacco use, health risks, consequences of tobacco use, approaches to tobacco control and the role of health professionals on tobacco control, the pathophysiology of addiction to nicotine. Also, instructions were given to participants regarding the evidence-based treatment of tobacco dependence and the development of CVD, diabetes and COPD. Case studies and role playing were used as part of the training.
Concerning the methods used for data collection during the pilot study on providers, all health care professionals provided written informed consent. All consenting providers completed the TOB.g provider survey immediately before (time 1) the TOB.g training session which assessed provider demographic characteristics, tobacco treatment knowledge, tobacco treatment self‐efficacy, and current rates of tobacco treatment delivery.. At the end of the training day (time 2), providers completed a post‐training survey. Providers also completed the follow‐up survey six months (time3) following the completion of the training program.
Secondly, the intervention for patients included a follow-up phone call to patients 1‐ and 6‐months after their clinic appointment to assess quit attempts, and smoking status. Patients who reported they had quit smoking, they were asked to provide a bio‐chemical cotinine sample.

Work performed during the reporting period

During its first half of implementation the TOB.g project focused on the situation analysis and the development of the specialised set of tobacco cessation guidelines for five groups. Thus, scientific working groups of health professionals were established and an extensive literature review was performed.
In the second half, the TOB.g project mainly focused on the pilot implementation and the assessment of the TOB.g guidelines. The activities that took place regarding the pilot implementation were:
(a) Development of the specifications for the pilot’s organization as well as the methodology for the assessment of the draft guidelines
(b) Training seminars in Greece and Romania to health professionals who later on conducted the pilot sessions to their patients,
(c) Formulation of groups for each target group to conduct the pilot implementation of the guidelines.
(d) Direct intervention/consultation of the trained health professionals with the patients, follow up and assessment that was used as feedback for the preparation of the final version of the guidelines.
(e) Reporting of pilot sessions. The corresponding pilot assessment report provided detailed information on the pilot implementation methodology and the results on the assessment and effectiveness of the guidelines.
Moreover, within TOB.g it was essential to facilitate the training of health professionals on how to use the guidelines and provide each health care professional with specific information about each high risk group that they encounter during their routine clinical practice. Thus, additional training sessions took place and the TOB.g eLearning course was developed and attended by more than 100 healthcare professionals.
Finally, a variety of dissemination channels and instruments, such as online dissemination (web sites, e-newsletters, social media), internal and external events, conferences and workshops scientific peer reviewed manuscripts etc., were used which the dissemination and communication of the project’s outcomes were realized.

The main output achieved so far and their potential impact and use by target group (including benefits)

SMOKING CESSATION GUIDELINES
The main project outcome is a set of smoking cessation guidelines that have been developed based on the specific needs of high risk groups which were the target groups of the project. The guidelines developed contain strategies and recommendations designed to assist health professionals in delivering and supporting effective treatment of tobacco dependence. Recommendations are made as a result of scientific reviews and evidence of good practices from scientific groups that consisted of health professionals of different expertise in Europe.
The expected future impact of the TOB-G guidelines is:
• More effective and appropriate treatment of tobacco dependence
• Quicker diagnosis of tobacco related diseases
• Long term prevention of tobacco related diseases (healthier babies and adults, less medical complications, fewer deaths)
• Better trained physicians and practitioners
• Promote healthy lifestyles &
• Promote healthy role-models.
The final product was a guideline book that was published by KEELPNO: ISBN: 978-960-98654-6-3. The book is also available in English and French at the TOB.g project web site.

TRAINING SEMINARS TO HEALTH PROFESSIONALS
The pilot implementation of the TOB-G guidelines was an important stage of the project as it provided significant information in order to address the effectiveness and usefulness of the guidelines and acquire important feedback for further improvement. The pilot implementation took in Greece and Romania and it consisted of two phases: (a) direct intervention with the patients (meetings with the health professionals, consultations etc.) and (b) six months follow up of the patients via communication in important milestones.
In order the health professionals to successfully conduct the smoking cessation interventions to their patients using the TOB-G recommendations, they first participated in training sessions. Most of the participants from all training seminars, found very helpful several sessions of the workshop. More specifically, motivational interviewing, counselling skills and some practical cases (i.e. interview with the patients) had a great impact and influence on the audience. In general, the intention of the participants to provide smoking cessation counselling in practice was increased after the intervention. Specifically, after the intervention they recorded high scores and they seem to have a great intention to provide smoking cessation counselling over the next 6 months.

E-LEARNING COURSE
The project also aimed to provide further training to health professionals in cost effective ways, since the developed guidelines acted as a tool to conduct early diagnosis and offer appropriate treatment of chronic diseases related to tobacco dependence. In this context, an e-learning course was developed and relevant sessions were organised aiming to train health professionals and give them knowledge and skills for the implementation of the smoking cessation guidelines in high risk groups.
The e-learning course addressed issues, such as epidemiological data on smoking habits, needs of high risk groups and differences between them, practical information about the use of the guidelines and key suggestions for individualised interventions. The structure of the e-course was based on the guidelines. 76 women and 30 men have participated in the TOB.g e-course, representing 15 EU member states and 9 non-EU countries and the majority of the participants liked the platform’s design and felt confident using it.

Achieved outcomes compared to the expected outcomes

The smoking cessation guidelines are based on the specific needs of the five high risk groups that are the project targets i.e. Cardiovascular diseases patients, Chronic obstructive pulmonary disease (COPD) patients, Adults suffering from Type 2 Diabetes, Adolescents and Pregnant women. Thus, health professionals have increased access to medical expertise and information regarding to tobacco related health risks and will improve their health literacy. Moreover, health professionals from different expertise have benefited from the project’s training activities on the use of the guidelines and implementation in health practice, obtaining skills useful to help stop the tobacco epidemic.
Moreover, the e-learning course and the training sessions provided a great experience and training to health professionals to adopt and adapt the content of the training material and the guidelines into their everyday clinical practice and techniques. Overall, TOB-G project has achieved its expected outcomes up to now. In addition, a contract amendment requested from the TOB-g partnership has been accepted by the Agency, including updates on specific deliverables delivery dates and the inclusion of subcontracting that was not initially foreseen.

Dissemination and evaluation activities carried out so far and their major results

The project considered the Dissemination activities as a continuous process that runs through the project’s lifecycle. During the first half of the project, the Dissemination WP focused on developing the dissemination plan and the main dissemination channels and instruments through which the dissemination and communication of the project’s outcomes will be realized. In the second half of the project, the Dissemination WP focused on implementing the dissemination plan and adopting the main dissemination channels and instruments through which the dissemination and communication of the project’s outcomes were realized. The overall TOB.g framework for dissemination includes:
• The TOB.g web site was available since the beginning of the project and regularly updated with project news, outcomes and results. Through the website all project public deliverables are available to all kind of stakeholders that have an interest in the tobacco prevention epidemics and tobacco cessation, mainly TOB.g tobacco cessation guidelines in English and French and the TOB.g e-learning course.
• Electronic newsletters with TOB.g developments were sent to the dissemination list of ENSP that provided useful information about the project, updates and events and direct links to the project’s website.
• Presentation of the TOB.g project in several external and internal conferences, events as well as in informative consultations meetings.
• Presentation of the TOB.g findings in training sessions, publications and newsletters and through several professional networks.
• Communication through social media, national and local press, which also formed key channels for communicating the progress of the TOB.g research work.
• Scientific peer reviewed manuscripts were created and submitted for publication.