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E of computer-tailored S moking C essation A dvice in P rimary car E A Randomised Controlled Trial. ffectiveness. Hazel Gilbert Department of Primary Care and Population Sciences UCL. Smoking Cessation Interventions. Clinical approach Intensive face-to-face Relatively high quit rates - PowerPoint PPT Presentation
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E of computer-tailored Smoking Cessation Advice in Primary
carE A Randomised Controlled Trial
ffectiveness
Hazel GilbertDepartment of Primary Care and Population SciencesUCL
Clinical approach
• Intensive face-to-face• Relatively high quit rates• Low participation rates• Unrepresentative
Smoking Cessation Interventions
Public health campaigns
• Large-scale programs
• Impersonal• High reach• Low quit rates
Longer term data collected from two PCTs Oct 2001 to March 2003
4 week abstinence 53% 52 week abstinence 15% consistent with published studies
Low participation rates 6% of smokers use the services per year 1% of smokers are helped to stop long-term
NHS Smoking Cessation Service
To increase success rates in clinics
Reach the smokers who do not use clinics
Challenges for Primary Care
Self-help MaterialsSelf-help Materials
Generic leaflets and manuals
Personalised generic
Targeted materials to particular groups
Individually Tailored FeedbackDefinition: ‘intended to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment’ (Kreuter et al 1999)
Proactive recruitment
Contact individuals directly offering a service
Higher participation
More demographically representative
Escape trial is proactively recruiting smokers by sending questionnaires to a large population group using GP records
participation rates of
public health
campaigns
behavioural intervention principles of the clinical approach
provide personal, individually tailored
self-help reports for a large population of
smokers
Tailored feedback + Proactive Recruitment
Smokers not motivated to quit
Areas of high deprivation where smoking prevalence is higher
Primary Care Networks can help us to target these specific population groups and achieve the objectives
Targeting specific population groups
Aimed to recruit 100 MRC GPRF practices, representing high and low socio-economic areas
116 expressed an interest in the study
Ranked practice postcodes from least to most deprived by Carstairs scores
Allocated to deprivation quintiles
Selected proportionally from each quintile
Practice RecruitmentPractice Recruitment
DeprivationQuintiles
England Scotland Wales All
1 6 3 1 10
2 9(-1) 4 1 14
3 25(+10) 2 1 28
4 20 1 21
5 23(-12) (-1) 23
Total 83(-3) 9(-1) 4 96(-4)
1) Practices identify current cigarette smokers aged 18 to 65 from records using the computer system
2) Randomly select a sample of 520
3) List screened by GP to exclude patients not appropriate e.g. terminal illness
4) Smokers (n=50,000) sent the Smoking Behaviour Questionnaire together with a covering letter from GP
Participant Recruitment
Estimate a response rate of 15% from 2 mailings (reminder and duplicate SBQ) to secure 7250 participants
Respondents by DeprivationRespondents by Deprivation
% questionnaires returned per practice by deprivation
0%
5%
10%
15%
1 2 3 4 5Deprivation quintile
Co-investigators
Professor Irwin NazarethDr Richard MorrisDepartment of Primary Care and Population Sciences, UCL
Professor Stephen SuttonInstitute of Public Health, University of Cambridge
Professor Christine GodfreyDepartment of Health Sciences, University of York
General PracticeResearchFramework
Respondents by practice
% questionnaires returned by practice
0%
5%
10%
15%
20%
25%
Respondents by readiness to quit
0
20
40
60
80
100
nex t 2 w eeks nex t 30 day s nex t 6 months not planning
Planning to quit
%
To examine the effect of computer generated individually tailored feedback reports designed to help and encourage smokers to quit, on quit rates and quitting activity, when sent to smokers with varying levels of motivation and reading ability, identified from GP lists
Aim
Respondents by newspaper read
Newspaper read
0
5
10
15
20
25
30
35
Sun/Mirror Express/Mail Times/Guardian
%
Smoking status, cognitive change, adherence to advice, perceptions of the feedback reports, and economic issues assessed by postal questionnaire at a 6-month follow-up
The Trial Interventions
Participants return the questionnaire to the research team at UCL. Randomly allocated to either:
Control Group Standard booklet Usual care offered by the practice
Intervention Group Standard booklet Usual care offered by general practice Computer-tailored feedback report Additional assessment and feedback report one
month after baseline received
Expected outcomes
Simple and inexpensive intervention
Low-cost, high-reach approach that can complement and extend the brief advice given by GPs
Enable the standardised collection of relevant information by practice nurses or other health professionals, and can be used to structure and reinforce the advice given
Could offer an efficient tool to integrate smoking cessation counselling into a busy primary care practice
Why do we need research into smoking cessation?
Leading preventable cause of disease and death
Smoking is a modifiable behaviour
Approximately 25% of the population still smoke
Respondents by regionRespondents by region
% questionnaires returned per practice by region
0%
5%
10%
15%
20%
Lond
on
Nor
th W
est
East
of E
ngla
nd
Wes
t Mid
land
s
York
shire
Sout
h Ea
st C
oast
Sout
h W
est
Wal
es
Nor
th E
ast
Sout
h C
entra
l
Scot
land
Respondents by qualifications
Qualifications
05
10152025303540
none GSCE A level Degree Postgrad
%
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