Chronic Disease Management for Tobacco Dependence

Joseph, Anne M.; Fu, Steven S.; Lindgren, Bruce R.; Rothman, Alexander J.; Kodl, Molly; Lando, Harry A.; Doyle, Brandon; Hatsukami, Dorothy K.

doi:10.1001/archinternmed.2011.500

Cited by 83 publications

(89 citation statements)

References 31 publications

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“…67 Trials have also shown that extended use of NRT by ex-smokers may result in better long-term abstinence rates. 68,69 For this reason, NRT in the UK is licensed for smoking reduction, that is, dual use, and available to smokers who cannot or are unwilling to stop smoking completely, as a long-term harm reduction measure 70 NRT licensing is also being changed to allow its use for harm reduction purposes among ex-smokers. 71 Harm reduction refers to the reduced psychological or physiological harm from substance use without complete cessation.…”

Section: Rationale and Study Aimsmentioning

confidence: 99%

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

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BackgroundNHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned.ObjectivesThe main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives.DesignThe ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use.SettingThe setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services.ParticipantsThere were 202,804 cases included in secondary analysis and 3075 in the prospective study.InterventionsA combination of behavioural support and stop smoking medication delivered by SSS practitioners.Main outcome measuresAbstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test.ResultsJust over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected.ConclusionsStop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012–13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites.FundingThe National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.

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Section: Rationale and Study Aimsmentioning

confidence: 99%

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

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“…This study does exactly that. More intensive treatments, even within primary care settings, are likely more eﬀective than the brief interventions tested herein [35–37]. However, sustaining such interventions after completion of a study is questionable.…”

Section: Discussionmentioning

confidence: 99%

Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial

Dahne

Wahlquist

Boatright

et al. 2018

Contemporary Clinical Trials

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Background: Primary care is the most important point of healthcare contact for smokers. Brief physician advice to quit, based on the 5As/AAR model, offers some efficacy but is inconsistently administered and has limited population impact. Nicotine replacement therapy (NRT) sampling, defined as provision of a brief NRT starter kit, when added to the 5As/AAR, is well-suited to primary care because it is simple, brief, and can be provided to all smokers. This article describes the design and methods of an ongoing comparative effectiveness trial testing standard care vs. standard care + NRT sampling within primary care. Methods: Smokers were recruited directly from primary care practices between July 2014 and December 2017 within an established network of South Carolina clinics. Interventions were delivered randomly by clinic personnel, and phone-based follow-ups were centrally coordinated by research staff to track outcomes through six months post-intervention. Primary study aims are to examine the impact of NRT sampling on smoking, inclusive of cessation, quit attempts, and uptake of evidence-based treatment. Results: Twenty-two clinics were recruited. Across clinics, patient census ranged from 985 to 10,957 and number of providers ranged from 1 to 63. Average patient age across clinics was 52.9 years and smoking prevalence across ranged from 10.6% to 28.5%. Conclusion: Improving the effectiveness and reach of brief interventions within primary care could have a considerable impact on population quit rates. We consider the advantages and disadvantages of key methodological decisions relevant to the design of future primary care-based cessation trials.

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“…39 Tobacco dependence is a chronic disease, thus relapses should not be viewed as failures, but as expected events in the course of attempted long-term abstinence. 40 The likelihood of successful long-term smoking cessation increases with repeated quit attempts, 41 and as such care providers should address the topic regularly and repeatedly over time, even if the patient is originally reluctant to quit. For former smokers, physicians must continue to actively support abstinence by evaluating the ongoing mental and/or physical compulsions to resume smoking.…”

Section: Outpatient Management Of Copd Prevention and Lifestyle Modifmentioning

confidence: 99%

Advances in the Outpatient Management of Chronic Obstructive Pulmonary Disease

Possick

Most

Rochester

2013

Clinical Pulmonary Medicine

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Chronic obstructive pulmonary disease (COPD) remains highly prevalent, underdiagnosed, and a major cause of morbidity and mortality. Disease rates and cost of care continue to rise annually in the United States and worldwide. Recent years have seen advances in our understanding of COPD as a heterogenous disease with distinct phenotypes. It is increasingly recognized that COPD severity and impact is complex and is inadequately described by airflow obstruction alone. The revised 2011 GOLD guidelines now incorporate multidimensional measures of symptom burden, functional limitations, and exacerbation frequency in patient assessment. Moreover, COPD is commonly associated with multiple medical co-morbidities that also have an impact on the symptom burden, disease severity, and mortality for individual patients. This conceptual frame-shift to recognition of COPD as a heterogenous and multifaceted disease with varying impact on the patient has begun to revolutionize the way COPD care is approached in the outpatient setting. Current management guidelines now emphasize broader-based patient assessment including characterization of patients' phenotypes, symptom burden, functional limitations, exacerbation risk, and co-morbidities to guide therapeutic interventions. Although some forms of therapy continue to be applicable to all patients with COPD, others seem to only benefit patients with selected disease phenotypes. Here we explore some of the recent advances in outpatient COPD management. We consider the varying manifestations of COPD, treatment approaches that remain broadly applicable, as well as selected phenotype-specific treatments, interventions targeted at reducing exacerbations, and management of intractable symptoms. We also suggest areas for future exploration.

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Chronic Disease Management for Tobacco Dependence

Cited by 83 publications

References 31 publications

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial

Advances in the Outpatient Management of Chronic Obstructive Pulmonary Disease

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