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INTRODUCTION: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS: A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS: A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS: The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.
ABSTRACT
BACKGROUND: Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. OBJECTIVE: This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. METHODS: This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A's (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. RESULTS: The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). CONCLUSIONS: A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. TRIAL REGISTRATION: Clinicaltrials.gov NCT03445507; https://tinyurl.com/mrnfcmtd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12911-019-0972-z.
Subject(s)
Smoking Cessation , Telemedicine , Tobacco Use Cessation , Adult , Female , Humans , Male , Middle Aged , Primary Health Care , Smoking Cessation/methods , Tobacco Use Cessation/methods , Treatment OutcomeABSTRACT
El Proyecto ÉVICT (Evictproject.org), a raíz del aumento de consumo de cannabis en población juvenil española, ha estudiado su asociación con el tabaco, concluyendo que el consumo conjunto de tabaco y cannabis: tiene una influencia en el proceso de aprender a fumar, pues el inicio puede ser conjunto y con influencia bidireccional; tiene una influencia en el desarrollo de dependencia pues su interacción es relevante para el desarrollo de este trastorno, y tiene una influencia en la toxicidad, pues probablemente, el fumar tabaco y cannabis genera mayores problemas que fumar solo una de las 2. Y, por tanto, el equipo EVICT emite unas consideraciones en prevención: diferenciar uso medicinal y recreativo; comunicar que fumar cannabis no es terapéutico ni inocuo, y puede ayudar a generar dependencia de nicotina o, menos frecuentemente, al propio cannabis. Consideraciones en abordaje y tratamiento: en personas que consumen tabaco/cannabis debemos plantear como primera opción el cese de las 2 sustancias. Consideraciones en reducción de daños: a quienes solo consumen productos de tabaco/cannabis, los programas serían más aplicables a aquella cuyo consumo se considere más problemático
EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence. Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic
Subject(s)
Humans , Adolescent , Young Adult , Adult , Middle Aged , Smoking/epidemiology , Smokers , Tobacco Use Disorder/epidemiology , Substance-Related Disorders/epidemiology , Marijuana Abuse/epidemiology , Codependency, Psychological , Tobacco Use Disorder/prevention & control , Smoking Prevention/legislation & jurisprudenceABSTRACT
EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic.
Subject(s)
Marijuana Smoking , Tobacco Smoking , Adolescent , Adult , Aged , Ambulatory Care , Female , Humans , Male , Marijuana Smoking/adverse effects , Marijuana Smoking/prevention & control , Middle Aged , Spain , Tobacco Smoking/adverse effects , Tobacco Smoking/prevention & controlABSTRACT
INTRODUCTION: Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation rates by the Spanish public healthcare system. METHODS: A pragmatic, randomized, clinical trial was performed by clusters. Randomization unit was the primary healthcare center and the analysis unit was the patient. Smokers consuming ≥10 cigarettes/day were randomly assigned to an intervention group that received financed pharmacological treatment or to a control group that followed usual care. The main outcome was self-reported or CO-confirmed continuous abstinence at 12 months. The main outcome, continuous abstinence rates (%), were compared between groups at 12 months post-intervention. A model was adjusted using mixed-effect logistic regression. RESULTS: A total of 1154 patients were included from 23 healthcare centers. In the intention-to-treat analysis, self-reported abstinence after 12 months in the control and intervention groups, respectively, was 9.6% (37/387) and 15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1-2.8); for CO-confirmed abstinence the corresponding values were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted OR=1.72; 95% CI: 0.7-4.0). Pharmacological treatment use was 35.1% (136/387) in the control group, and 58.3% (447/767) in the intervention group (adjusted OR=4.25; 95% CI: 1.8-9.9). CONCLUSIONS: Subsidizing pharmacological treatment for smoking cessation increases self-reported or CO-confirmed abstinence rates under realistic conditions in the primary care setting of the Spanish public health system.
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No disponible
Subject(s)
Humans , Smoking/adverse effects , Cardiovascular Diseases/epidemiology , Risk Factors , Secondary Prevention , Smoking Cessation , Tobacco Use Cessation , Health CouncilsSubject(s)
Cardiovascular Diseases/etiology , Tobacco Use/adverse effects , Cardiovascular Diseases/prevention & control , Counseling , Disease Progression , Humans , Plaque, Atherosclerotic/etiology , Plaque, Atherosclerotic/prevention & control , Risk , Risk Factors , Secondary Prevention , Smoking Cessation , Tobacco Use/prevention & controlABSTRACT
Existen intervenciones muy eficaces y eficientes para ayudar a nuestros pacientes a dejar de fumar. La estrategia que goza de mayor evidencia y consenso para atención primaria es la de las 5 aes, es decir, preguntar, aconsejar, valorar la disposición a intentar dejar de fumar, ayudar a aquellos que quieren intentarlo y hacer visitas de seguimiento. Sin embargo, intervenimos menos de lo que deberíamos en nuestros pacientes fumadores. Los protocolos disponibles nos proponen a veces intervenciones sobredimensionadas, sin evidencia científica ni repercusión terapéutica. Creemos que es necesario realizar intervenciones más sencillas, útiles y basadas en la evidencia que nos ayuden en el desempeño de nuestro trabajo, dejando de hacer aquellas que no aporten. En este artículo usaremos como ejemplo una revisión crítica del servicio de Atención al Fumador de la Cartera de Servicios de la Comunidad de Madrid y propondremos una serie de alternativas que permitan una intervención más sencilla, efectiva y basada en pruebas
We do have very effective and efficient interventions to help our patients to stop smoking. The strategy that has more evidence and consensus in primary care is the 5 A's, that is, ask, advise, assess willingness to try to quit smoking, helping those who want to try and make follow-up visits. However, we intervene lot less than we should. The available protocols oversized interventions, and propose elements without scientific evidence or therapeutic effect. It is therefore necessary to develop more simple, useful and evidence-based interventions to assist us in carrying out our work interventions, and stop doing those that don' t contribute. In this article we will use as an example a critical review of Smoker Care Service Portfolio of Madrid Health Service, and we will propose a number of alternatives to allow a simple, effective and evidence-based intervention
Subject(s)
Humans , Male , Female , Adult , Smoking/epidemiology , Smoking/prevention & control , Smoking Prevention , Primary Health Care/methods , Primary Health Care/organization & administration , Primary Health Care/standards , Basic Health Services , Tobacco Use Cessation/methods , Tobacco Use Cessation/statistics & numerical data , Health Services/standards , Health ServicesABSTRACT
We do have very effective and efficient interventions to help our patients to stop smoking. The strategy that has more evidence and consensus in primary care is the 5 A's, that is, ask, advise, assess willingness to try to quit smoking, helping those who want to try and make follow-up visits. However, we intervene lot less than we should. The available protocols oversized interventions, and propose elements without scientific evidence or therapeutic effect. It is therefore necessary to develop more simple, useful and evidence-based interventions to assist us in carrying out our work interventions, and stop doing those that dont contribute. In this article we will use as an example a critical review of Smoker Care Service Portfolio of Madrid Health Service, and we will propose a number of alternatives to allow a simple, effective and evidence-based intervention.
Subject(s)
Primary Health Care , Smoking Cessation , Humans , Smoking , NicotianaABSTRACT
INTRODUCTION: Advice can have a small but clinically important effect in promoting smoking cessation. Where studied, the rate of delivery has been found to be low. Training has been found to increases this rates, but there is little research on effectiveness in terms of smoking cessation rates. This study aimed to assess the effectiveness and cost-effectiveness of an health professionals educational program to increase long-term rates of nicotine abstinence in smoking outpatients. METHODS: We conducted a pragmatic cluster-randomized, controlled trial in 35 primary health care centers in Spain. Participants were all 830 health professionals who attended 5,970 smokers during recruiting period. After that we measured continuous abstinence 6 months after the intervention and biochemically validated (saliva cotinine test) 1 year following intervention. Cost-effectiveness was measured in terms of cost per life year gained. RESULTS: After 6 months, the rate of continuous abstinence was significantly higher in the intervention group (2.1% vs. 0.3%, p > .0001) with an odds ratio of 6.5 (95% CI = 3.3-12.7). After 1 year, biochemical validation was performed on 31 of the 67 patients previously registered as abstinent. All of them were abstinent and belonged to intervention group. The incremental cost per life year gained after 6 months was 969. CONCLUSIONS: A primary care training program on smoking cessation based on scientific evidence, behavioral theory, and active learning methods increases long-term continuous nicotine abstinence rate among outpatients in a significant way. These may be relevant for planning training of professionals, clinical assistance, and public health programs.
Subject(s)
Smoking Cessation/methods , Tobacco Use Disorder/therapy , Adult , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Smoking Cessation/economics , Surveys and QuestionnairesABSTRACT
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