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

%