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Lemain L, Lever D, Therene-Mouden C, Verdeau R, Barais M, Guillou-Landreat M. Chemsex Among Men Having Sex with Men: A Scoping Review on Management, Support, and Harm Reduction Strategies. JOURNAL OF SEX RESEARCH 2024:1-11. [PMID: 39093301 DOI: 10.1080/00224499.2024.2377592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Chemsex defines the practice of sexual activity under the influence of psychoactive substances, mainly by Men who have Sex with Men (MSM). This activity can be associated with negative health consequences, yet there are no recommendations to guide management of individuals who engage in chemsex. The aim of this scoping review was to identify and describe the existing treatments (pharmacological or not) and risk/harm reduction strategies for MSM who engage in chemsex. This scoping review was performed using PubMed and Embase databases and according to the PRISMA Extension for Scoping Review criteria. Overall, 19 studies were included in the review. Among these studies, four main themes were identified: management and harm reduction strategies, key actors involved in managing MSM who engage in chemsex, perceived barriers to care and the role of pre-exposure prophylaxis, and medical information sought by MSM who engage in chemsex. This scoping review concludes with the need to develop multidisciplinary approaches to improve communication about chemsex, and to design interventional studies that target MSM who engage in chemsex.
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Affiliation(s)
- Loic Lemain
- Addictology Service, University Hospital of Brest, Université de Bretagne occidentale
- ER 7479 SPURBO, University of Western Brittany
| | - Delphine Lever
- Addictology Liaison, University Hospital of Brest, CHU de Brest
| | | | - Romain Verdeau
- Department of General Practice, University of Western Brittany
| | - Marie Barais
- ER 7479 SPURBO, University of Western Brittany
- Department of General Practice, University of Western Brittany
| | - Morgane Guillou-Landreat
- ER 7479 SPURBO, University of Western Brittany
- Addictology Liaison, University Hospital of Brest, CHU de Brest
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Shorey Fennell B, Cottrell-Daniels C, Hoover DS, Spears CA, Nguyen N, Piñeiro B, McNeill LH, Wetter DW, Vidrine DJ, Vidrine JI. The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework. Transl Behav Med 2023; 13:551-560. [PMID: 37000697 PMCID: PMC10415728 DOI: 10.1093/tbm/ibad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.
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Affiliation(s)
| | | | | | - Claire A Spears
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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Immediate, Remote Smoking Cessation Intervention in Participants Undergoing a Targeted Lung Health Check: Quit Smoking Lung Health Intervention Trial, a Randomized Controlled Trial. Chest 2023; 163:455-463. [PMID: 35932889 PMCID: PMC9899638 DOI: 10.1016/j.chest.2022.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. RESEARCH QUESTION Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? STUDY DESIGN AND METHODS In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. RESULTS Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. INTERPRETATION Immediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. TRIAL REGISTRY ISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com.
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Minian N, Mehra K, Rose J, Veldhuizen S, Zawertailo L, Ratto M, Lecce J, Selby P. Cocreation of a conversational agent to help patients adhere to their varenicline treatment: A study protocol. Digit Health 2023; 9:20552076231182807. [PMID: 37377562 PMCID: PMC10291536 DOI: 10.1177/20552076231182807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Objective Varenicline is the most efficacious approved smoking cessation medication, making it one of the most cost-effective clinical interventions for reducing tobacco-related morbidity and mortality. Adhering to varenicline is strongly associated with smoking cessation. Healthbots have the potential to help people adhere to their medications by scaling up evidence-based behavioral interventions. In this protocol, we outline how we will follow the UK's Medical Research Council's guidance to codesign a theory-informed, evidence-based, and patient-centered healthbot to help people adhere to varenicline. Methods The study will utilize the Discover, Design and Build, and Test framework and will include three phases: (a) a rapid review and interviews with 20 patients and 20 healthcare providers to understand barriers and facilitators to varenicline adherence (Discover phase); (b) Wizard of Oz test to design the healthbot and get a sense of the questions that chatbot has to be able to answer (Design phase); and (c) building, training, and beta-testing the healthbot (Building and Testing phases) where the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework will be used to develop the healthbot using the simplest sensible solution, and 20 participants will beta test the healthbot. We will use the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change and its associated framework, the Theoretical Domains Framework, to organize the findings. Conclusions The present approach will enable us to systematically identify the most appropriate features for the healthbot based on a well-established behavioral theory, the latest scientific evidence, and end users' and healthcare providers' knowledge.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kamna Mehra
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jonathan Rose
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Scott Veldhuizen
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Matt Ratto
- Faculty of Information, University of Toronto, Toronto, ON, Canada
- Schwartz Reisman Institute for Technology and Society, University of Toronto, Toronto, ON, Canada
| | - Julia Lecce
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab (formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Siddiqi AD, Britton M, Chen TA, Carter BJ, Wang C, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9647. [PMID: 35955001 PMCID: PMC9367734 DOI: 10.3390/ijerph19159647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 05/11/2023]
Abstract
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers' perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients' interest in quitting and providers' potential impacts on a successful quit attempt.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Carol Wang
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
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6
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Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Bernstein SL, Carter PM, Meurer W, Walton MA, Kidwell KM, Cunningham RM, Dziura J, Collins LM. Advances in clinical trials methodology: Intervention optimization approaches in emergency medicine. Am J Emerg Med 2022; 53:6-11. [PMID: 34968972 PMCID: PMC8844226 DOI: 10.1016/j.ajem.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America; Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - William Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Maureen A Walton
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Kelly M Kidwell
- Department of Statistics, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America; University of Michigan Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
| | - James Dziura
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America
| | - Linda M Collins
- The Methodology Center and Department of Human Development & Family Studies, Penn State, University Park, PA, United States of America
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van Dover TJ, Kim DD. Do Centers for Medicare and Medicaid Services Quality Measures Reflect Cost-Effectiveness Evidence? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1586-1591. [PMID: 34711358 DOI: 10.1016/j.jval.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/22/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Despite its importance of quality measures used by the Centers for Medicare and Medicaid Services, the underlying cost-effectiveness evidence has not been examined. This study aimed to analyze cost-effectiveness evidence associated with the Centers for Medicare and Medicaid Services quality measures. METHODS After classifying 23 quality measures with the Donabedian's structure-process-outcome quality of care model, we identified cost-effectiveness analyses (CEAs) relevant to these measures from the Tufts Medical Center CEA Registry based on the PICOTS (population, intervention, comparator, outcome, time horizon, and setting) framework. We then summarized available incremental cost-effectiveness ratios (ICERs) to determine the cost-effectiveness of the quality measures. RESULTS The 23 quality measures were categorized into 14 process, 7 outcome, and 2 structure measures. Cost-effectiveness evidence was only available for 8 of 14 process measures. Two measures (Tobacco Screening and Hemoglobin bA1c Control) were cost-saving and quality-adjusted life-years (QALYs) improving, and 5 (Depression Screening, Influenza Immunization, Colon Cancer Screening, Breast Cancer Screening, and Statin Therapy) were highly cost-effective (median ICER ≤ $50 000/QALY). The remaining measure (Fall Screening) had a median ICER of $120 000/QALY. No CEAs were available for 15 measures: 10 defined by subjective patient ratings and 5 employed outcome measures without specifying an intervention or process. CONCLUSIONS When relevant CEAs were available, cost-effectiveness evidence was consistent with quality measures (measures were cost-effective). Nevertheless, most quality measures were based on subjective ratings or outcome measures, posing a challenge in identifying supporting economic evidence. Refining and aligning quality measures with cost-effectiveness evidence can help further improve healthcare efficiency by demonstrating that they are good indicators of both quality and cost-effectiveness of care.
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Affiliation(s)
- Timothy J van Dover
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - David D Kim
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
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Uppal A, Oxlade O, Nsengiyumva NP, N'Diaye DS, Alvarez GG, Schwartzman K. Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis. BMC Public Health 2021; 21:280. [PMID: 33536003 PMCID: PMC7860224 DOI: 10.1186/s12889-021-10187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. METHODS We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. RESULTS Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7-11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5-3%) compared to the tobacco cessation strategy alone, but at significant cost. CONCLUSIONS Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security.
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Affiliation(s)
- Aashna Uppal
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Ntwali Placide Nsengiyumva
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Dieynaba S N'Diaye
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, Department of Medicine, Division of Respirology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec, Canada.
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Fortmann SP, Bailey SR, Brooks NB, Hitsman B, Rittner SS, Gillespie SE, Hill CN, Leo MC, Crawford PM, Hu W, King DS, O'Cleirigh C, Puro J, Ann McBurnie M. Trends in smoking documentation rates in safety net clinics. Health Serv Res 2020; 55:170-177. [PMID: 31930738 PMCID: PMC7080378 DOI: 10.1111/1475-6773.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the impact of provider incentive policy on smoking status documentation. DATA SOURCES Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). STUDY DESIGN This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. DATA EXTRACTION METHODS We extracted structured EMR data for patients age 18 and older with at least one primary care visit. PRINCIPAL FINDINGS Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. CONCLUSIONS Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.
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Affiliation(s)
| | - Steffani R. Bailey
- Department of Family MedicineOregon Health and Science UniversityPortlandOregon
| | - Neon B. Brooks
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | - Brian Hitsman
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Sarah Stuart Rittner
- AllianceChicagoChicagoIllinois
- Present address:
SASU Project ManagementChicagoIllinois
| | | | | | - Michael C. Leo
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | - Weiming Hu
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | - Conall O'Cleirigh
- The Fenway InstituteBostonMassachusetts
- Massachusetts General HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Jon Puro
- Research Informatics and AnalyticsOCHIN, Inc.PortlandOregon
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12
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Hussen MA, Etu ES. The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia. Tob Induc Dis 2019; 17:74. [PMID: 31768166 PMCID: PMC6843185 DOI: 10.18332/tid/112668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/15/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cessation attempts for smokeless tobacco (SLT) have been studied in the countries that provide comprehensive cessation services, but there is no evidence about SLT cessation in Ethiopia, where there are no comprehensive tobacco cessation services. The objective of this study was to determine cessation attempts and related factors among daily SLT users. METHODS We analyzed the data obtained from a cross-sectional survey of SLT users in Borena zone, Ethiopia, focusing on a subset of 600 daily SLT users. Participants were adult SLT users aged ≥18 years. The dependent variable was SLT cessation attempt. Multivariable logistic regression was performed to identify association between cessation attempts and explanatory variables. Analyses were performed using SPSS version 20. RESULTS Overall, 18.5% reported having tried to quit SLT in the past 12 months. In multivariable analyses, SLT cessation attempts were significantly associated with being male (AOR=1.96, 95% CI: 1.13-3.40), current dual-product user (AOR=2.11, 95% CI: 1.31-3.38), being advised by α health professional (AOR=1.82, 95% CI: 1.13-2.92), current knowledge (AOR=1.20, 95% CI: 1.00-1.44), and risk perception (AOR=1.06, 95% CI: 1.02-1.10). CONCLUSIONS A low cessation attempt rate among daily SLT users calls for comprehensive cessation intervention. More attention to factors such as knowledge of the health consequences of SLT use, risk perception and health workers advice will be required to encourage cessation attempts.
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Affiliation(s)
- Mamusha A. Hussen
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Edao S. Etu
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
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13
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Tai EW, Guy GP, Steele CB, Henley SJ, Gallaway MS, Richardson LC. Cost of Tobacco-related Cancer Hospitalizations in the U.S., 2014. Am J Prev Med 2018; 54:591-595. [PMID: 29397279 PMCID: PMC6080196 DOI: 10.1016/j.amepre.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Smoking has been causally linked to 12 tobacco-related cancers: oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, lung, cervix, bladder, kidney, and acute myeloid leukemia. Tobacco-related cancers-related morbidity and mortality have been well described, but little is known about the prevalence of tobacco-related cancer hospitalizations and associated costs. This study estimates the annual number of tobacco-related cancer hospitalizations and their associated direct medical costs in the U.S. METHODS This study examined data from the 2014 National Inpatient Sample, the largest publicly available all-payer inpatient care database in the U.S. The authors calculated number of hospitalizations, total costs, length of stay, and cost per stay for tobacco-related cancer hospitalizations and cancer hospitalizations not related to tobacco. RESULTS In 2014, there were an estimated 461,295 annual tobacco-related cancer hospitalizations at a cost of $8.2 billion in the U.S. Tobacco-related cancers accounted for 45% of total cancer hospitalizations and cancer hospitalization costs. Compared with cancer hospitalizations not related to tobacco, tobacco-related cancer hospitalizations had a longer mean length of stay (6.8 vs 5.7 days). CONCLUSIONS The burden of tobacco-related cancer hospitalizations is substantial in the U.S. These findings highlight the importance of tobacco prevention and cessation efforts to decrease the burden of tobacco-related cancers in the U.S.
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Affiliation(s)
- Eric W Tai
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - C Brooke Steele
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Jane Henley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael S Gallaway
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Outcomes for a Public Hospital Tobacco Cessation Program: The Cook County Health and Hospitals System Experience. J Community Health 2018; 41:1130-1139. [PMID: 27393143 DOI: 10.1007/s10900-016-0215-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study is to determine the rate and predictors of sustained smoking cessation for a cohort of smokers exposed to a guideline-based health education program delivered during routine clinical care at an urban public hospital. This is a retrospective analysis of 755 public hospital system patients who had at least two health educator contacts embedded in routine clinical care, with the latter contact 12-18 months after the baseline. The education occurred during visits to primary care, specialty clinics, urgent/episodic care, or during hospitalization. The assessment of smoking status is determined by the health educators as part of their routine assessment and recorded in the program's database. The primary outcomes are self-reported 12-month sustained smoking cessation at the 12-18 month contact and predictors of cessation. The cohort is predominantly minority smokers (African American 69 % and Latino 15 %) and uninsured (70 %) or on Medicaid (13 %). The sustained cessation rate was 9.3 %. Latino ethnicity, smoking 1-9 cigarettes/day at baseline, reporting smoke-free home, and additional educator contact in the year after the baseline were independent predictors of sustained cessation in the multivariate analysis. Smokers with multiple risks for poor cessation outcomes exposed to a guideline-based program of health education during routine healthcare encounters had sustained smoking cessation rates that compare favorably with published National Health Interview Study population cessation rates. An additional educator contact after the baseline was a predictor of cessation. The findings support development of cessation programs in which health educators are integrated into clinical care settings.
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16
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Yang W, Zou Q, Tan E, Watkins L, Beronja K, Hogan PF, Elenberg K. Future Health and Economic Impact of Comprehensive Tobacco Control in DoD: A Microsimulation Approach. Mil Med 2017; 183:e104-e112. [DOI: 10.1093/milmed/usx015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wenya Yang
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Quan Zou
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Eleonora Tan
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Lachlan Watkins
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Kaleigh Beronja
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Paul F Hogan
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Kimberly Elenberg
- Department of Defense, U.S. Public Health Service, OUSD(P&R)/Force Resiliency; Pentagon, Room 2E593, Washington, DC 20301-3010
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17
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Selby P, Hunter K, Rogers J, Lang-Robertson K, Soklaridis S, Chow V, Tremblay M, Koubanioudakis D, Dragonetti R, Hussain S, Zawertailo L. How to adapt existing evidence-based clinical practice guidelines: a case example with smoking cessation guidelines in Canada. BMJ Open 2017; 7:e016124. [PMID: 29102984 PMCID: PMC5722096 DOI: 10.1136/bmjopen-2017-016124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework. METHODS An independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption. RESULTS The final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations. CONCLUSIONS This method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders.
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Affiliation(s)
- Peter Selby
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katie Hunter
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
- Centre for Effective Practice, Toronto, Ontario, Canada
| | - Jess Rogers
- Centre for Effective Practice, Toronto, Ontario, Canada
| | | | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Virginia Chow
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
| | - Michèle Tremblay
- Institut National de Santé Publique du Québec, Montreal, Québec, Canada
| | | | - Rosa Dragonetti
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
| | - Sarwar Hussain
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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A Proactive Telephone-Delivered Risk Communication Intervention for Smokers Participating in Lung Cancer Screening: A Pilot Feasibility Trial. J Smok Cessat 2017. [DOI: 10.1017/jsc.2017.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Many barriers exist to integrating smoking cessation into delivery of lung cancer screening including limited provider time and patient misconceptions.Aims: To demonstrate that proactive outreach from a telephone counsellor outside of the patient's usual care team is feasible and acceptable to patients.Methods: Smokers undergoing lung cancer screening were approached for a telephone counselling study. Patients agreeing to participate in the intervention (n = 27) received two telephone counselling sessions. A 30-day follow-up evaluation was conducted, which also included screening participants receiving usual care (n = 56).Results/Findings: Most (89%) intervention participants reported being satisfied with the proactive calls, and 81% reported the sessions were helpful. Use of behavioural cessation support programs in the intervention group was four times higher (44%) compared to the usual care group (11%); Relative Risk (RR) = 4.1; 95% CI: 1.7 to 9.9), and seven-day abstinence in the intervention group was double (19%) compared to the usual care group (7%); RR = 2.6; 95% CI: 0.8 to 8.9).Conclusions: This practical telephone-based approach, which included risk messages clarifying continued risks of smoking in the context of screening results, suggests such messaging can boost utilisation of evidence-based tobacco treatment, self-efficacy, and potentially increase the likelihood of successful quitting.
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20
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An Interdisciplinary Response to a Tobacco Cessation Case Vignette. J Smok Cessat 2017. [DOI: 10.1017/jsc.2016.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction:Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.Aims:The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.Methods:ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.Results/Findings:While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.Conclusions:Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services.
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Heydari G. Is Cost of Medication for Quit Smoking Important for Smokers, Experience of Using Champix in Iranian Smoking Cessation Program 2016. Int J Prev Med 2017; 8:63. [PMID: 28966752 PMCID: PMC5609398 DOI: 10.4103/ijpvm.ijpvm_375_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/28/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Providing smoking cessation services are special importance to tobacco control programs. To date, Champix is a new expensive medication for smoking cessation available nationally. Champix has both agonist and antagonist activities and can reduce nicotine dependence and withdrawal symptoms. The purpose of this study was to evaluate the duration of using Champix based on its cost. Methods: This quasi-experimental study was conducted with smokers presenting to the Tanaffos Smoking Cessation Clinic in Tehran, Iran 2016. Smokers were visited by a physician 3 times at 1-week intervals for counseling. Smokers started to use Champix and stopped smoking in the 2nd week of counseling and were followed up by phone and through regular visits to the clinic at 1, 3, and 6 months postintervention. Some of them did not continue medication for 12 weeks because of its cost. Results: A total of 227 smokers including 133 males (58%) with a mean age of 43 years were enrolled of whom 116 (51.1%), 89 (43.6%), and 34 (20.6%) had quit smoking after 1, 3, and 6 months, respectively. Quit rates were significantly higher among those who used Champix for more than 6 weeks, and this rate was not correlated with age, sex, educational level, or nicotine dependence. Conclusions: Use of Champix for more than 6 weeks increases the quitting success rate compared with using for a shorter time. The cost of Champix was important for smokers and adding Champix to the list of insurance medication or getting it free of charge is needed.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Minh HV, Ngan TT, Mai VQ, My NTT, Chung LH, Kien VD, Anh TT, Ngoc NB, Giap VV, Cuong NM, Manh PD, Giang KB. Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges. Asian Pac J Cancer Prev 2017; 17:1-9. [PMID: 27087176 DOI: 10.7314/apjcp.2016.17.s1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.
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Gaskill CE, Kling CE, Varghese TK, Veenstra DL, Thirlby RC, Flum DR, Alfonso-Cristancho R. Financial benefit of a smoking cessation program prior to elective colorectal surgery. J Surg Res 2017; 215:183-189. [PMID: 28688645 DOI: 10.1016/j.jss.2017.03.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/07/2017] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cigarette smoking increases the risk of postoperative complications nearly 2-fold. Preoperative smoking cessation programs may reduce complications as well as overall postoperative costs. We aim to create an economic evaluation framework to estimate the potential value of preoperative smoking cessation programs for patients undergoing elective colorectal surgery. METHODS A decision-analytic model from the payer perspective was developed to integrate the costs and incidence of 90-day postoperative complications and readmissions for a cohort of patients undergoing elective colorectal surgery after a smoking cessation program versus usual care. Complication, readmission, and cost data were derived from a cohort of 534 current smokers and recent quitters undergoing elective colorectal resections in Washington State's Surgical Care and Outcomes Assessment Program linked to Washington State's Comprehensive Hospital Abstract Reporting System. Smoking cessation program efficacy was obtained from the literature. Sensitivity analyses were performed to account for uncertainty. RESULTS For a cohort of patients, the base case estimates imply that the total direct medical costs for patients who underwent a preoperative smoking cessation program were on average $304 (95% CI: $40-$571) lower per patient than those under usual care during the first 90 days after surgery. The model was most sensitive to the odds of recent quitters developing complications or requiring readmission, and smoking program efficacy. CONCLUSIONS A preoperative smoking cessation program is predicted to be cost-saving over the global postoperative period if the cost of the intervention is below $304 per patient. This framework allows the value of smoking cessation programs of variable cost and effectiveness to be determined.
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Affiliation(s)
- Cameron E Gaskill
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
| | - Catherine E Kling
- Department of Surgery, University of Washington, Seattle, Washington; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas K Varghese
- Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - David L Veenstra
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington
| | - Richard C Thirlby
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington
| | - Rafael Alfonso-Cristancho
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington
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Sherman SE, Krebs P, York LS, Cummins SE, Kuschner W, Guvenc-Tuncturk S, Zhu SH. Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models. Tob Control 2017; 27:78-82. [PMID: 28190003 DOI: 10.1136/tobaccocontrol-2016-053327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. METHODS Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers' Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. OUTCOME Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). CONCLUSION Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible. TRIAL REGISTRATION NUMBER NCT00123682.
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Affiliation(s)
- Scott E Sherman
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Paul Krebs
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Laura S York
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Ware Kuschner
- VA Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sebnem Guvenc-Tuncturk
- Department of Pulmonary and Critical Care Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
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Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and Maine. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:40-7. [PMID: 26131658 DOI: 10.1097/phh.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prevalence of smoking is particularly high among individuals with low socioeconomic status and who may be receiving Medicaid benefits. This study evaluates the public health and economic impact of providing coverage for nicotine replacement therapy with no out-of-pocket cost to the adult Medicaid population in Alabama, Georgia, and Maine, in 2012. We estimated the increase in the number of quitters and the savings in Medicaid medical expenditures associated with expanding Medicaid coverage of nicotine replacement therapy to the entire adult Medicaid population in the 3 states. With an expansion of Medicaid coverage of nicotine replacement therapy from only pregnant women to all adult Medicaid enrollees, the state of Alabama might expect 1873 to 2810 additional quitters ($526,203 and $789,305 in savings of annual Medicaid expenditures from both federal and state funds), Georgia 2911 to 4367 additional quits ($1,455,606 and $2,183,409 savings), and Maine 1511 to 2267 additional quits in ($431,709 and $647,564 savings). The expansion of coverage for smoking cessation therapy with no out-of-pocket cost could reduce Medicaid expenditures in all 3 states.
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Maciosek MV, LaFrance AB, Dehmer SP, McGree DA, Xu Z, Flottemesch TJ, Solberg LI. Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults. Ann Fam Med 2017; 15:37-47. [PMID: 28376459 PMCID: PMC5217842 DOI: 10.1370/afm.2022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. METHODS We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews. RESULTS Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates. CONCLUSIONS Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.
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Affiliation(s)
| | | | | | | | - Zack Xu
- HealthPartners Institute, Minneapolis, Minnesota
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Cawkwell PB, Lee L, Shearston J, Sherman SE, Weitzman M. The Difference a Decade Makes: Smoking Cessation Counseling and Screening at Pediatric Visits. Nicotine Tob Res 2016; 18:2100-2105. [PMID: 27613894 PMCID: PMC5055743 DOI: 10.1093/ntr/ntw146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/20/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children. METHODS Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics. RESULTS In 1997-1999, 1.5% of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8% in 2009-2011 (P < .001). A marked increase from 4.1% to 11.1% was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95% CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95% CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses. CONCLUSION These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented. IMPLICATIONS A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.
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Affiliation(s)
- Philip B Cawkwell
- Department of Pediatrics, New York University School of Medicine, New York, NY;
| | - Lily Lee
- Department of Pediatrics, New York University School of Medicine, New York, NY
- Brooklyn College, New York, NY
| | | | - Scott E Sherman
- College of Global Public Health, New York University, New York, NY
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, NY
- College of Global Public Health, New York University, New York, NY
- NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
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Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study. J Gen Intern Med 2016; 31:1198-205. [PMID: 27329121 PMCID: PMC5023615 DOI: 10.1007/s11606-016-3781-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/27/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population. OBJECTIVE We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers. DESIGN Longitudinal observational cohort study using electronic health record data from a network of Oregon CHCs linked to Oregon Medicaid enrollment data. PATIENTS Cohort of patients who smoke and who gained Medicaid coverage in 2008-2011 after ≥ 6 months of being uninsured and with ≥ 1 smoking assessment in the 24-month follow-up period from the baseline smoking status date. This group was propensity score matched to a cohort of continuously uninsured CHC patients who smoke (n = 4140 matched pairs; 8280 patients). INTERVENTION Gaining Medicaid after being uninsured for ≥ 6 months. MAIN MEASURES 'Quit' smoking status (baseline smoking status was 'current every day' or 'some day' and status change to 'former smoker' at a subsequent visit), smoking cessation medication order, and ≥ 6 documented visits (yes/no variables) at ≥ 1 smoking status assessment within the 24-month follow-up period. KEY RESULTS The newly insured had 40 % increased odds of quitting smoking (aOR = 1.40, 95 % CI:1.24, 1.58), nearly triple the odds of having a medication ordered (aOR = 2.94, 95 % CI:2.61, 3.32), and over twice the odds of having ≥ 6 follow-up visits (aOR = 2.12, 95 % CI:1.94, 2.32) compared to their uninsured counterparts. CONCLUSIONS Newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured. Providing insurance coverage to vulnerable populations may have a significant impact on smoking cessation.
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Feirman SP, Glasser AM, Teplitskaya L, Holtgrave DR, Abrams DB, Niaura RS, Villanti AC. Medical costs and quality-adjusted life years associated with smoking: a systematic review. BMC Public Health 2016; 16:646. [PMID: 27460828 PMCID: PMC4962483 DOI: 10.1186/s12889-016-3319-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/16/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Estimated medical costs ("T") and QALYs ("Q") associated with smoking are frequently used in cost-utility analyses of tobacco control interventions. The goal of this study was to understand how researchers have addressed the methodological challenges involved in estimating these parameters. METHODS Data were collected as part of a systematic review of tobacco modeling studies. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Studies were eligible for the current analysis if they were U.S.-based, provided an estimate for Q, and used a societal perspective and lifetime analytic horizon to estimate T. We identified common methods and frequently cited sources used to obtain these estimates. RESULTS Across all 18 studies included in this review, 50 % cited a 1992 source to estimate the medical costs associated with smoking and 56 % cited a 1996 study to derive the estimate for QALYs saved by quitting or preventing smoking. Approaches for estimating T varied dramatically among the studies included in this review. T was valued as a positive number, negative number and $0; five studies did not include estimates for T in their analyses. The most commonly cited source for Q based its estimate on the Health Utilities Index (HUI). Several papers also cited sources that based their estimates for Q on the Quality of Well-Being Scale and the EuroQol five dimensions questionnaire (EQ-5D). CONCLUSIONS Current estimates of the lifetime medical care costs and the QALYs associated with smoking are dated and do not reflect the latest evidence on the health effects of smoking, nor the current costs and benefits of smoking cessation and prevention. Given these limitations, we recommend that researchers conducting economic evaluations of tobacco control interventions perform extensive sensitivity analyses around these parameter estimates.
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Affiliation(s)
- Shari P. Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
| | - Allison M. Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
| | - Lyubov Teplitskaya
- Evaluation Science and Research, Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - David R. Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - David B. Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC 20007 USA
| | - Raymond S. Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC 20007 USA
| | - Andrea C. Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Ruhil R. Correlates of the Use of Different Tobacco Cessation Methods by Smokers and Smokeless Tobacco Users According to Their Socio-Demographic Characteristics: Global Adult Tobacco Survey (GATS) India 2009-10. Indian J Community Med 2016; 41:190-7. [PMID: 27385871 PMCID: PMC4919931 DOI: 10.4103/0970-0218.183598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/16/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tobacco control has two aspects. One involves preventing non-tobacco users from using tobacco and the second involves tobacco cessation (quitting) by existing tobacco users. There are various methods of tobacco cessation. Pharmacotherapy [e.g., nicotine replacement therapy (NRT) and medications such as bupropion] and behavioral counselling are some of the internationally approved methods of tobacco cessation. OBJECTIVE This paper intends to study how age, gender, residence (rural/urban), education, and occupation influence the use of various tobacco cessation methods by smokers and smokeless tobacco users. MATERIALS AND METHODS The study was a cross-sectional secondary data analysis of the Global Adult Tobacco Survey (GATS) India 2009-2010. There were 3725 smokers and 6354 smokeless tobacco users included in the study who made attempts to quit in the 12 months prior to the survey by use of different cessation methods (NRT, drugs such as bupropion, counselling, and other methods). RESULTS A significant association was demonstrated between increasing educational attainment and use of cessation methods for all the methods among smokers. Being employed (Govt. or non-Govt.) was positively associated with the use of NRT as a cessation method by smokers. Students and homemakers had higher odds of using pharmacotherapy methods among smokers. A significant association was demonstrated for the gender and age of tobacco users with the use of counselling as a cessation method among smokeless tobacco users. CONCLUSION The findings of this study have important implications for tobacco cessation service providers in view of supporting their decision of choosing a particular tobacco cessation method for tobacco users according to certain kinds of sociodemographic characteristics.
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Affiliation(s)
- Rohini Ruhil
- Scholar, Centre for Social Medicine and Community Health, Jawaharlal Nehru University (JNU), New Delhi - 110067, India
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31
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Kruger J, O'Halloran A, Rosenthal AC, Babb SD, Fiore MC. Receipt of evidence-based brief cessation interventions by health professionals and use of cessation assisted treatments among current adult cigarette-only smokers: National Adult Tobacco Survey, 2009-2010. BMC Public Health 2016; 16:141. [PMID: 26868930 PMCID: PMC4751655 DOI: 10.1186/s12889-016-2798-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background Helping tobacco smokers to quit during a medical visit is a clinical and public health priority. Research suggests that most health professionals engage their patients in at least some of the ‘5 A’s’ of the brief cessation intervention recommended in the U.S. Public Health Service Clinical Practice Guideline, but information on the extent to which patients act on this intervention is uncertain. We assessed current cigarette-only smokers’ self-reported receipt of the 5 A’s to determine the odds of using optimal cessation assisted treatments (a combination of counseling and medication). Methods Data came from the 2009–2010 National Adult Tobacco Survey (NATS), a nationally representative landline and mobile phone survey of adults aged ≥18 years. Among current cigarette-only smokers who visited a health professional in the past 12 months, we assessed patients’ self-reported receipt of the 5 A’s, use of the combination of counseling and medication for smoking cessation, and use of other cessation treatments. We used logistic regression to examine whether receipt of the 5 A’s during a recent clinic visit was associated with use of cessation treatments (counseling, medication, or a combination of counseling and medication) among current cigarette-only smokers. Results In this large sample (N = 10,801) of current cigarette-only smokers who visited a health professional in the past 12 months, 6.3 % reported use of both counseling and medication for smoking cessation within the past year. Other assisted cessation treatments used to quit were: medication (19.6 %); class or program (3.8 %); one-on-one counseling (3.7 %); and telephone quitline (2.6 %). Current cigarette-only smokers who reported receiving all 5 A’s during a recent clinic visit were more likely to use counseling (odds ratio [OR]: 11.2, 95 % confidence interval [CI]: 7.1–17.5), medication (OR: 6.2, 95 % CI: 4.3–9.0), or a combination of counseling and medication (OR: 14.6, 95 % CI: 9.3–23.0), compared to smokers who received one or none of the 5 A’s components. Conclusions Receipt of the ‘5 A’s’ intervention was associated with a significant increase in patients’ use of recommended counseling and medication for cessation. It is important for health professionals to deliver all 5 A’s when conducting brief cessation interventions with patients who smoke.
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Affiliation(s)
- Judy Kruger
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 30341, USA. .,Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., F-79, Atlanta, GA, 30341-3724, USA.
| | - Alissa O'Halloran
- Contractor (NGIS) for Office on Smoking and Health, National Center for Chronic Disease Prevention, Atlanta, GA, 30341, USA
| | | | - Stephen D Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 30341, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53711, USA
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Salepci B, Fidan A, Çağlayan B, Parmaksız ET, Kıral N, Cömert SŞ, Güngör GA, Salepci E. Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently? Turk Thorac J 2015; 17:15-21. [PMID: 29404116 DOI: 10.5578/ttj.17.1.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication. MATERIAL AND METHODS Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation. RESULTS A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p< 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029). CONCLUSION More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.
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Affiliation(s)
- Banu Salepci
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ali Fidan
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Benan Çağlayan
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Elif Torun Parmaksız
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Nesrin Kıral
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Sevda Şener Cömert
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Gülten Aktin Güngör
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Egehan Salepci
- Student of 6 Grade, Trakya University Faculty of Medicine, Edirne, Turkey
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Jacobson RM, Isham GJ, Finney Rutten LJ. Population Health as a Means for Health Care Organizations to Deliver Value. Mayo Clin Proc 2015; 90:1465-70. [PMID: 26410573 DOI: 10.1016/j.mayocp.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | | | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Heydari G, Masjedi M, Ahmady AE, Leischow SJ, Harry AL, Shadmehr MB, Fadaizadeh L. Assessment of Different Quit Smoking Methods Selected by Patients in Tobacco Cessation Centers in Iran. Int J Prev Med 2015; 6:81. [PMID: 26442750 PMCID: PMC4587069 DOI: 10.4103/2008-7802.164118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/07/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health systems play key roles in identifying tobacco users and providing evidence-based care to help them quit. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess different quit smoking methods selected by patients in tobacco cessation centers in Iran in order to identify those that are most appropriate for the country health system. METHODS In this cross-sectional and descriptive study, a random sample of all quit centers at the country level was used to obtain a representative sample. Patients completed the self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. RESULTS A total of 1063 smokers returned completed survey questionnaires. The most frequently used methods were Nicotine Replacement Therapy (NRT) and combination therapy (NRT and Counseling) with 228 and 163 individuals reporting these respectively. The least used methods were hypnotism (n = 8) and the quit and win (n = 17). The methods which gained the maximum scores were respectively the combined method, personal and Champix with means of 21.4, 20.4 and 18.4. The minimum scores were for e-cigarettes, hypnotism and education with means of 12.8, 11 and 10.8, respectively. There were significant differences in mean scores based on different cities and different methods. CONCLUSIONS According to smokers' selection the combined therapy, personal methods and Champix are the most effective methods for quit smoking and these methods could be much more considered in the country health system.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Ebn Ahmady
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Scott J Leischow
- Department of Research, College of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - A Lando Harry
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
| | - Mohammad B Shadmehr
- Tracheal Diseases Research Center, National Research Institute of TB and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of TB and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Heydari G, Masjedi M, Ebn Ahmady A, Leischow SJ, Lando HA, Shadmehr MB, Fadaizadeh L. Quit Smoking Experts' Opinions toward Quality and Results of Quit Smoking Methods Provided in Tobacco Cessation Services Centers in Iran. Int J Prev Med 2015; 6:74. [PMID: 26425329 PMCID: PMC4564900 DOI: 10.4103/2008-7802.162667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 04/07/2015] [Indexed: 11/30/2022] Open
Abstract
Background: One of the core responsibilities of health system is to treat tobacco dependence. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess physicians’ opinions towards quality and result of different quit smoking methods provided in tobacco cessation services centers in Iran. Methods: In this cross-sectional and descriptive study, random sampling of all quit centers at country level was used to obtain a representative sample size of 100 physicians. Physicians completed a self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects, and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. Results: Most experts preferred to use combination quit smoking methods and then Nicotine Replacement Therapy (NRT) with 26 and 23, respectively. The least used methods were quit line and some methods without medication with 3 cases. The method which gained the maximum scores were telephone consultation, acupuncture, Willpower, Champix, combined method, and Interactive Voice Response (IVR) with the mean of 23.3, 23, 22.5, 22, 21.7 and 21.3, respectively. The minimum scores were related to e-cigarette, some methods without medication, and non-NRT medication with the mean of 12.3, 15.8 and 16.2, respectively. There were no significant differences in the mean of scores based on different cities (P = 0.256). Analysis of variance in mean scores showed significant differences in the means scores of different methods (P < 0.000). Conclusions: According to physicians acupuncture, personal methods and Champix are the most effective methods and these methods could be much more feasible and cost effective than other methods.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Ebn Ahmady
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Scott J Leischow
- Department of Research, College and Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Harry A Lando
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
| | - Mohammad B Shadmehr
- Tracheal Diseases Research Center, National Research Institute of TB and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of TB and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Complementary and Alternative Medicine (CAM) practitioners’ readiness for tobacco intervention training: Development and psychometric properties of a new measure. ADVANCES IN INTEGRATIVE MEDICINE 2015. [DOI: 10.1016/j.aimed.2014.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maciosek MV, Xu X, Butani AL, Pechacek TF. Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach. Prev Med 2015; 77:162-7. [PMID: 26051203 PMCID: PMC4597893 DOI: 10.1016/j.ypmed.2015.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. METHOD We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex, and cigarette smoking status. Sensitivity analyses explored assumptions of the method. RESULTS Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35-54years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis, these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. CONCLUSION Sex- and age-group-specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers' excess medical care costs is preventable by quitting.
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Affiliation(s)
- Michael V Maciosek
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Xin Xu
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy L Butani
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Terry F Pechacek
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Oelke ND, Suter E, da Silva Lima MAD, Van Vliet-Brown C. Indicators and measurement tools for health system integration: a knowledge synthesis protocol. Syst Rev 2015; 4:99. [PMID: 26220097 PMCID: PMC4518647 DOI: 10.1186/s13643-015-0090-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health system integration is a key component of health system reform with the goal of improving outcomes for patients, providers, and the health system. Although health systems continue to strive for better integration, current delivery of health services continues to be fragmented. A key gap in the literature is the lack of information on what successful integration looks like and how to measure achievement towards an integrated system. This multi-site study protocol builds on a prior knowledge synthesis completed by two of the primary investigators which identified 10 key principles that collectively support health system integration. The aim is to answer two research questions: What are appropriate indicators for each of the 10 key integration principles developed in our previous knowledge synthesis and what measurement tools are used to measure these indicators? To enhance generalizability of the findings, a partnership between Canada and Brazil was created as health system integration is a priority in both countries and they share similar contexts. METHODS/DESIGN This knowledge synthesis will follow an iterative scoping review process with emerging information from knowledge-user engagement leading to the refinement of research questions and study selection. This paper describes the methods for each phase of the study. Research questions were developed with stakeholder input. Indicator identification and prioritization will utilize a modified Delphi method and patient/user focus groups. Based on priority indicators, a search of the literature will be completed and studies screened for inclusion. Quality appraisal of relevant studies will be completed prior to data extraction. Results will be used to develop recommendations and key messages to be presented through integrated and end-of-grant knowledge translation strategies with researchers and knowledge-users from the three jurisdictions. DISCUSSION This project will directly benefit policy and decision-makers by providing an easy accessible set of indicators and tools to measure health system integration across different contexts and cultures. Being able to evaluate the success of integration strategies and initiatives will lead to better health system design and improved health outcomes for patients.
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Affiliation(s)
- Nelly D Oelke
- School of Nursing, University of British Columbia, Okanagan 3333 University Way, Kelowna, British Columbia, V1V 1V7, Canada.
| | - Esther Suter
- Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada.
| | | | - Cheryl Van Vliet-Brown
- School of Nursing, University of British Columbia, Okanagan 3333 University Way, Kelowna, British Columbia, V1V 1V7, Canada.
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Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2015; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
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Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Mc Conalogue D, Kierans C, Moran A. The hidden practices and experiences of healthcare practitioners dealing with fuel poverty. J Public Health (Oxf) 2015; 38:206-11. [PMID: 25968133 DOI: 10.1093/pubmed/fdv059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fuel poverty negatively impacts a population's health affecting life chances along the life course. Moreover, it represents a substantial inequality in the UK. Healthcare practitioners (HCPs) have a key role in identifying and supporting patients who are fuel poor. METHODS A qualitative inquiry with District Nurses and General Practitioners, to explore their understanding and experiences of dealing with patients living in fuel poverty. RESULTS Participants recognize fuel poverty by observing material cues. They perceive their relationship with the patient as pivotal to recognizing the fuel poor. Practitioners' sense of responsibility for their patients' social concerns is determined by their knowledge about the link to health outcomes. The services that they sign-post to are motivated by their experience dealing with the service, or their patients' experiences of the service. CONCLUSION Participants' reliance on temporary material cues resulted in few experiences of recognition of the fuel poor. HCPs' perceptions of patient pride and the lack of personal relationship between doctor and patient presented barriers to identifying fuel poor patients. A limitation of this study is the small sample size of nine participants. These came from two professional groups, which afforded more depth of exploration, but may limit applicability to other professionals.
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Affiliation(s)
- D Mc Conalogue
- Health Education North West, Mersey Deanery, Liverpool L3 4BL, UK
| | - C Kierans
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GL, UK
| | - A Moran
- North West Knowledge and Intelligence Team, Public Health England, Manchester M20 3LJ, UK
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Muramoto ML, Matthews E, Ritenbaugh CK, Nichter MA. Intervention development for integration of conventional tobacco cessation interventions into routine CAM practice. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:96. [PMID: 25887742 PMCID: PMC4391469 DOI: 10.1186/s12906-015-0604-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022]
Abstract
Background Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners – that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. Methods Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. Results CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. Conclusions The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner’s role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners’ work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners’ clinical behavior is underway.
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Rogers ES, Fu SS, Krebs P, Noorbaloochi S, Nugent SM, Rao R, Schlede C, Sherman SE. Proactive outreach for smokers using VHA mental health clinics: protocol for a patient-randomized clinical trial. BMC Public Health 2014; 14:1294. [PMID: 25518878 PMCID: PMC4301886 DOI: 10.1186/1471-2458-14-1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/01/2014] [Indexed: 12/03/2022] Open
Abstract
Background Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).
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Affiliation(s)
- Erin S Rogers
- VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA.
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Medicare's use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2014; 119:156-63. [PMID: 25498476 DOI: 10.1016/j.healthpol.2014.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/01/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022]
Abstract
CONTEXT Medicare currently pays for 23 preventive services in its benefits package, the majority of which were added since 2005. In the past decade, the program has transformed from one essentially administering treatment claims, to one increasingly focused on health promotion and maintenance. What is largely unappreciated is the role cost-effectiveness analysis has played in the coverage of preventive services. METHODS We review the role of cost-effectiveness analysis in Medicare coverage of preventive services and contrast it to the lack of such consideration in the coverage of treatments. FINDINGS While not considered for coverage of treatment, cost-effectiveness analysis played a role in the coverage of nine preventive services, and was evaluated in a number of instances when the service was not added. Pneumococcal vaccine, the first preventive service added to the benefit (1981), followed a Congressionally requested cost-effectiveness analysis, which showed it to be cost-saving. More recently, the Centers for Medicare and Medicaid Services (CMS) reviewed cost-effectiveness evidence when covering preventive services such as HIV screening (2010) and screening and behavioral counseling for alcohol misuse (2011) (studies reported cost-effectiveness ratios of $55,440 per QALY, and $1755 per QALY, respectively). CONCLUSIONS Cost-effectiveness analysis has played a longstanding role in informing the addition of preventive services to Medicare. It offers Medicare officials information they can use to help ensure health gains are achieved at reasonable cost. However, limiting cost-effectiveness evidence to prevention and not treatment is inconsistent and potentially inefficient.
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Enrolling Smokers from Health Systems into Quitline Services: ‘Results of two enrollment strategies’. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To determine the effects of motivational interviewing (MI) counselling versus a minimal intervention control on the enrollment of smokers in the Minnesota QUITPLAN Helpline.Study design: Two-group randomized controlled trial of 235 community-dwelling adult smokers. Participants were randomly assigned to receive either a three-session phone based motivational interviewing intervention (n = 118) or the control (n = 117) consisting of mailed printed materials about the Minnesota QUITPLAN helpline services.Data collection: Participants completed demographic and smoking-related survey questionnaire at baseline (by mail) and at weeks 4 and 26 (by phone) follow-up. Quitline enrollment status data was provided by the Minnesota QUITPLAN Helpline.Principal findings: At week 4 follow-up, a higher proportion of participants in the MI group (22.3%) had enroled in the Minnesota QUITPLAN Helpline compared to those in the control arm (13.6%; p = 0.098). At week 26 follow-up, enrollment rates were similar for MI (28.0%) and control (26.5%) arms. Of those who enroled in the Helpline, participants in the MI group reported completing more Helpline sessions than those in control group (4.9 vs. 3.2; p = 0.087).There was no significant interaction between readiness to quit and intervention for the outcome of enrollment in the Helpline.Conclusions: A minimal intensity control such as mailing printed materials resulted in quitline enrollment rates similar to a more resource intensive intervention like motivational interviewing and several folds higher than the current state or national averages. We recommend that health plans should consider mailing smoking cessation promotional messages to encourage smokers to enrol in quitlines.
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Ferketich AK, Pennell M, Seiber EE, Wang L, Farietta T, Jin Y, Wewers ME. Provider-delivered tobacco dependence treatment to Medicaid smokers. Nicotine Tob Res 2014; 16:786-93. [PMID: 24474305 DOI: 10.1093/ntr/ntt221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking prevalence is 49% among Medicaid enrollees in Ohio. The objective of this pilot project was to test a comprehensive tobacco dependence treatment program targeting rural Medicaid-enrolled smokers for both physician-level and smoker-level outcomes. METHODS Using a group-randomized trial design, intervention group physicians (n = 4) were exposed to systems-level changes in their clinics, and smokers in these clinics were offered 12 weeks of telephone cessation counseling. Control group physicians (n = 4) were given the clinician's version of the U.S. Public Health Serivce (USPHS) Clinical Practice Guideline, and smokers in these clinics were given information about the Ohio Tobacco Quitline. Physician-level and smoker-level outcomes were assessed at 1 week and 3 months, respectively. Costs per quit were estimated. RESULTS A total of 214 Medicaid smokers were enrolled. At 1 week, there were no reported differences in rates of being asked about tobacco use (68% intervention, 58% control) or advised to quit (69% intervention, 63% control). However, 30% of intervention and 56% of control smokers reported receiving a prescription for pharmacotherapy (p < .01). At 3 months, there were no differences in quit attempts (58% intervention, 64% control), use of pharmacotherapy (34% intervention, 46% control), or abstinence (24% intervention, 16% control for self-reported abstinence; 11% intervention, 3.5% control for cotinine-confirmed abstinence). The intervention group proved more cost-effective at achieving confirmed quits ($6,800 vs. $9,700). CONCLUSIONS We found few differences in outcomes between physicians exposed to a brief intervention and physicians who were intensively trained. Future studies should examine how tobacco dependence treatment can be further expanded in Medicaid programs.
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Affiliation(s)
- Amy K Ferketich
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH
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McAfee T, Davis KC, Alexander RL, Pechacek TF, Bunnell R. Effect of the first federally funded US antismoking national media campaign. Lancet 2013; 382:2003-11. [PMID: 24029166 DOI: 10.1016/s0140-6736(13)61686-4] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign. METHODS We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data. FINDINGS 3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking. INTERPRETATION The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally. FUNDING CDC, US Department of Health and Human Services.
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Robert L Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terry F Pechacek
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nabi-Burza E, Winickoff JP, Finch S, Regan S. Triple tobacco screen: opportunity to help families become smokefree. Am J Prev Med 2013; 45:728-31. [PMID: 24237914 PMCID: PMC3860591 DOI: 10.1016/j.amepre.2013.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/04/2013] [Accepted: 07/29/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND American Academy of Pediatrics policy recommends that pediatricians document environmental tobacco smoke (ETS) exposure of a child at every visit. The extent to which pediatricians adhere to this policy, however, is unknown. PURPOSE The goal of the study was to examine the extent to which pediatricians screen parents for tobacco use and home- and car-related smoking rules. Further, the potential association between factors associated with pediatrician inquiry into parental tobacco use and rules is examined. METHODS Post-visit exit interviews were conducted in ten pediatric practices between June 2009 and March 2011 with parents whose children had been seen by a healthcare provider. Parents were considered to have been given the "triple tobacco screen" if they reported being asked by a pediatric healthcare provider about their smoking behavior, smokefree home rules, and smokefree car rules. Bivariate analysis and multivariable logistic regression was done to explore factors associated with parents being given any component of the triple tobacco screening. Data were analyzed between March 2012 and February 2013. RESULTS Of 9145 parents interviewed, 20% of the parents reported being asked at least one question from the triple tobacco screen, and only 9% reported being asked all three questions. Overall, 17% of parents reported being asked about their smoking status, 16% about smokefree home rules, and 11% about smokefree car rules. Few smoking parents (23%) and fewer nonsmoking parents (19%) were screened about their tobacco use and behavior. CONCLUSIONS Pediatricians infrequently addressed ETS exposure of children among parents who do and do not smoke. Substantial missed opportunities may exist to counsel smokers and reduce ETS exposure of children in the most common exposure locations-the home and car.
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Affiliation(s)
- Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts.
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Vidrine JI, Shete S, Li Y, Cao Y, Alford MH, Galindo-Talton M, Rabius V, Sharp B, Harmonson P, Zbikowski SM, Miles L, Wetter DW. The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med 2013; 45:737-41. [PMID: 24237916 PMCID: PMC4023543 DOI: 10.1016/j.amepre.2013.07.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/17/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment. PURPOSE Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system. DESIGN The study design was a pair-matched group-randomized trial with two treatment arms. SETTING/PARTICIPANTS Ten safety net clinics in Houston TX. INTERVENTION Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. MAIN OUTCOME MEASURES The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment. RESULTS The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06). CONCLUSIONS The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.
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Gao Y, Babazono A, Nishi T, Maeda T, Lkhagva D. Could investment in preventive health care services reduce health care costs among those insured with health insurance societies in Japan? Popul Health Manag 2013; 17:42-7. [PMID: 24134788 DOI: 10.1089/pop.2013.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined the impact of expenditures for preventive health care services on health care costs among those insured with health insurance societies in Japan using cross-sectional and longitudinal designs. The subjects of the study were those insured with Japan's 1481 health insurance societies belonging to the National Federation of Health Insurance Societies in 2003 and 2007. Multiple regression analyses were conducted using the forced entry method. Case rates, number of service days, and health care costs were used as dependent variables, and preventive health care expenditures, average age, number of the insured, gender ratio, average monthly salary, and dependents ratio were used as independent variables. Expenditures for preventive health care services showed significant negative correlations with both the number of service days and health care costs for inpatient and outpatient services in 2003 and 2007. The results showed that expenditures for preventive health care services had a negative relationship with health care costs. Thus, these findings support the effects of investment in preventive health activities as promoted by health insurance societies to reduce health care costs.
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Affiliation(s)
- Yan Gao
- 1 Department of Health Services Management and Policy, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan
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Hanna N, Mulshine J, Wollins DS, Tyne C, Dresler C. Tobacco Cessation and Control a Decade Later: American Society of Clinical Oncology Policy Statement Update. J Clin Oncol 2013; 31:3147-57. [DOI: 10.1200/jco.2013.48.8932] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nasser Hanna
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - James Mulshine
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Dana S. Wollins
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Courtney Tyne
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Carolyn Dresler
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
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