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Best Global Practices for Tobacco Control - National Institute for Respiratory Diseases, Mexico (Fall 2019)

Best Global Practices for Tobacco Control - National Institute for Respiratory Diseases, Mexico (Fall 2019)

National Institute for Respiratory Diseases, Mexico

Project Background:

The Tobacco Clinic (TC) at the National Institute of Respiratory Diseases (INER) aims to provide support to all smoking patients so that they can quit such a habit in Mexico. Currently, TC provides care to more than 300 patients with an 85% success rate once treatment is finished, 50% at 6 months and 35% at one year after treatment. Through a multidisciplinary team of medicine, psychology, nursing, and nutrition, the Clinic has a cognitive-behavioral program made of 10 group or individual sessions for 5 weeks. This program also includes medical consultation along with pharmacologic treatment to improve therapy outcomes. The whole Clinic’s program is available to the general population: any patient can enter the program. The cost of the sessions is decided according to a socioeconomic level study which varies between $20 and $200 USD. In case pharmacologic treatment is required, the patient will probably spend between $40 and $400 USD depending on his or her needs.

Furthermore, there is a monthly support session for ex-smokers to strengthen addiction cessation through three objectives: 1) Continuous professional interaction with patients so that follow up can be completed; 2) Connection with people ranging on different stages of the smoking cessation process; 3) Provide information regarding the impact tobacco has on patients’ health so that abstinence can be reinforced.

Besides its welfare component, the Clinic has a very important clinical research component, trying to associate different consumption patterns with genetic and functional variations, symptoms and patient prognosis. The TC is currently including dual users (patients that smoke both tobacco and marijuana) in its research and care groups. Moreover, the Clinic is nowadays the headquarters for the Interinstitutional Committee for Tobacco Control, a working group that gathers key stakeholders in private, public and hospital Institutions around Tobacco Control policies.

Definition of Opportunity:

Despite its 30 years of experience, the TC has not compared its model to other successful models for tobacco cessation. Nor has it expanded its influence through e-health. The TC has a limited impact mostly because its population comes almost exclusively from the patient population from inside INER. This limits most of its focus on patients older than 50 years with an already existent pulmonary and/or chronic disease. Thus, there is a need to attract younger populations. Moreover, there is a wide gap of knowledge regarding a patient who has drug addictions that can affect the lung such as inhaled polymers, cocaine and others. For this, the Clinic is currently trying to launch an app that can provide support for patients who want to quit smoking and at the same time feed the TC with data useful for research. Additionally, our Interinstitutional Committee has important and yet unused talent due to a lack of social communication and PR strategies.

Initial ideas:

Comparative work from what the TC does, compared with what other evidence-based centers are doing is extremely useful. Moreover, being able to compare what differences exist between developing and developed countries can help the Clinic find the middle ground that could scale its impact. Specifically exploring the following topics:

  • Best examples of Tobacco Cessation Group Session strategies

  • Tobacco Cessation Center’s outcome tracking and impact measurement

  • Use of e-health strategies to scale the Clinic’s impact

  • Successful Strategies for Tobacco Control Committees.

What does success look like:

Specific deliverables regarding the four areas shown above would help the Clinic greatly. Any further development of each one of these comparative tasks into an actual application to the TC would be most welcome. For example, if based on a comparative table of other Tobacco Center’s main impact measures, the team could aid the Clinic in creating its own or our joint project would really make a lasting difference.

Meet the Team:

Expanding Global Surgery as Part of the Global Health Agenda - Program of Global Surgery and Social Change, Philippines, (Fall 2019)

Expanding Global Surgery as Part of the Global Health Agenda - Program of Global Surgery and Social Change, Philippines, (Fall 2019)

Organizational Background:

The Program in Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH). This organization emerges out of work of the Lancet Commission on Global Surgery, that was led by Dr. John Meara at Harvard Medical School (and a 1986 ND graduate). PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. The strategy is two-fold: 1) Global Surgical Systems Strengthening through Research, Advocacy, and Implementation Science, using the Frameworks developed as part of the Lancet Commission on Global Surgery, and 2) Developing Leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. PGSSC's research focuses on surgical and health systems strengthening that is measurable, transparent, and locally-driven. Click here for the Strategic Plan that focuses on implementation science, research, advocacy, and training leaders.

The Opportunity:

The World Health Organization (WHO) Western Pacific Regional Office (WPRO) has developed a strategic health plan for the region. At the recent World Health Assembly in Geneva, the Regional Director for WPRO indicated his interest to integrate surgery into the regional health plan, and specifically promote the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) model for countries of the WPRO region, potentially including Philippines, Malaysia, Cambodia, Laos, Viet Nam and/or Mongolia.

Initial Steps:

One of the initial steps in the development of NSOAPs is a baseline analysis of a country’s current surgical capacity. Review the Tanzanian background research document that created a baseline for the Tanzania NSOAP as a first step to moving forward on the NSOAP process in the WPRO.

Identify with the client the most relevant countries to research.

Conduct a systematic review of academic literature and government policy documents, including form the Ministry of Health websites, to build a baseline on access to and the state of surgery in each of the selected countries.

What does success look like?

The development of research to support a set of future scenarios or pathways that PGSSC might use for potential partnerships with the WHO regional office to support the development of surgical policy, as well as the strategic use of their experience, expertise, and capacity to maximize their organization’s impact on global surgery goals.

Meet the Team: