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Fehily CM, Bartlem KM, Wiggers JH, Hodder RK, Gibson LK, Hancox N, Bowman JA. Uptake of a preventive care consultation offered to clients of a community mental health service. Prev Med Rep 2020; 18:101076. [PMID: 32226731 PMCID: PMC7093828 DOI: 10.1016/j.pmedr.2020.101076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
Preventive care to address client chronic disease risks is not frequently provided in community mental health services. Offering clients an additional preventive care consultation has been shown to increase client receipt of such care. The ability of this approach to have a beneficial impact at the population level is however dependent on its level of acceptability and uptake among clients. No studies have previously reported these outcomes when the additional consultation is universally offered to all clients of a community mental health service. To address this evidence gap, this descriptive study was undertaken to determine community mental health clients' (1) reported acceptability, in principle, of such a model of care, (2) of those who were offered the additional consultation, the level of uptake, and (3) clinical and socio-demographic characteristics associated with uptake. Participants were clients of one community mental health service in Australia. Data were collected in 2017 by telephone interviews and study records. Data from three distinct participant sub-groups are reported. In response to a hypothetical question, 79.3% of participants (n = 157) agreed that an offer of an additional preventive care consultation would be acceptable (Aim 1). Of the participants who were offered such a consultation (n = 264), 37.8% took up the offer (Aim 2); and no clinical or sociodemographic characteristics were significantly associated with uptake (Aim 3). Findings support the feasibility of this model of care. However, further research is needed to identify barriers to uptake, and effective strategies to enhance consultation uptake. Trial registration: ACTRN12616001519448.
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Affiliation(s)
- Caitlin M.C. Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - John H. Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Rebecca K. Hodder
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Lauren K. Gibson
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Natalie Hancox
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Jenny A. Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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Spaducci G, Richardson S, McNeill A, Pritchard M, Sanyal J, Healey A, Yates M, Robson D. An observational study of system-level changes to improve the recording of very brief advice for smoking cessation in an inpatient mental health setting. BMC Public Health 2020; 20:559. [PMID: 32334547 PMCID: PMC7183585 DOI: 10.1186/s12889-020-08672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient's smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). METHODS We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012-September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free policy; C) enhancements to the patient electronic healthcare record (EHCR) which included C1) a temporary form to record the financial incentivisation of ASK and ACT (OFFER) C2) amendments to how VBA was recorded in the EHCR and C3) the integration of a new electronic national referral system in the EHCR. The recording of ASK, ADVISE, ACT (OFFER/CONSENT) were extracted using a de-identified psychiatric case register. RESULTS There were 8976 admissions of 5434 unique individuals during the study period. Following A) financial incentive, the odds of recording ASK increased (OR: 1.56, 95%CI: 1.24-1.95). Following B) comprehensive smoke-free policy, the odds of recording ADVICE increased (OR: 3.36, 95%CI: 1.39-8.13). Following C1) temporary recording form, the odds of recording ASK (OR:1.99, 95%CI:1.59-2.48) and recording ACT (OFFER) increased (OR: 4.22, 95%CI: 2.51-7.12). Following C3) electronic referral system, the odds of recording ASK (OR:1.79, 95%CI: 1.31-2.43) and ACT (OFFER; OR: 1.09, 95%CI: 0.59-1.99) increased. There was no change in recording VBA outcomes following C2) amendments to VBA recording. CONCLUSIONS Financial incentives and the recording of incentivised outcomes, the comprehensive smoke-free policy, and the electronic referral system, were associated with increases in recording individual VBA elements, but other changes to the EHCR were not. System-level changes may facilitate staff recording of VBA provision in mental health settings.
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Affiliation(s)
- Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Sol Richardson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.,Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Megan Pritchard
- NIHR Maudsley Biomedical Research Centre & King's College London, De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Jyoti Sanyal
- NIHR Maudsley Biomedical Research Centre & King's College London, De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Andy Healey
- King's Improvement Science and King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London. David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Yates
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
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Kagabo R, Gordon AJ, Okuyemi K. Smoking cessation in inpatient psychiatry treatment facilities: A review. Addict Behav Rep 2020; 11:100255. [PMID: 32467844 PMCID: PMC7244912 DOI: 10.1016/j.abrep.2020.100255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 12/02/2022] Open
Abstract
Smoking rates are high among people with psychiatric illness. Smoking cessation interventions are rarely available in inpatient psychiatry settings. Smokers with psychiatric illness are just as interested in quitting smoking.
Background Tobacco-related diseases are a leading cause of death among individuals with severe mental illness (SMI), yet interventions to address tobacco cessation are rare in inpatient settings where persons with SMI are hospitalized. While cigarette smoking rates have declined in the general population, they remain high in persons with SMI. Inpatient settings would be a prime location to intervene on tobacco consumption among persons with SMI. The objective of this review was to examine evidence of smoking cessation interventions in psychiatric inpatient facilities. Method Using narrative overview guidelines, we searched PubMed, PsycINFO, and CINAHL for smoking cessation RCT studies published between 1950 and 2018. Studies included had to have at least started in inpatient psychiatry settings. Examples of search terms included: smoking cessation in inpatient psychiatry, smoking cessation in inpatient mental health treatment facilities, and smoking cessation and mental health. Results Following the inclusion criteria, eight RCT studies were reviewed. One study was among adolescent psychiatric inpatient smokers ages 13–17, and 7 were among adult psychiatric inpatients with mean age 41 years. Treatment periods lasting 8 to 12 weeks started in inpatient settings and continued post discharge. A combination of behavioral and pharmacological interventions were used. Pharmacological interventions were nicotine replacement therapies, and at least one study used varenicline. At baseline, participants smoked an average of 18.1 cigarettes per day. Conclusion Smoking cessation in inpatient psychiatry settings is rare or delayed. There is a need for more tailored treatments among this population to help them quit smoking.
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Affiliation(s)
- Robert Kagabo
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Corresponding author at: 375 Chipeta Way Ste. A, Salt Lake City, UT 84108, United States.
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Epperson AE, Anzai NE, Prochaska JJ. Natural American Spirit Brand Preference among Smokers with Mental Illness. Tob Induc Dis 2019; 16. [PMID: 31210981 PMCID: PMC6576234 DOI: 10.18332/tid/94456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite a steady decline in the US smoking prevalence over the past 50 years, Natural American Spirit cigarettes (NAS), marketed as ‘natural’ and ‘organic’, have seen a 400% rise in sales. In a sample of smokers with mental illness, based on previous research, we hypothesized that preference for NAS would be associated with younger age, higher education, and a stronger health-orientation. METHODS Adult smokers were interviewed during acute psychiatric hospitalization in California between 2009–2013, reporting their preferred top three brands of cigarettes, smoking behaviors, self-rated health, and dietary and physical activity behaviors. The sample (N=956; Mean age=38.7 years, SD=13.5; 48.7% women) identified as 14.5% Hispanic ethnicity, 49.6% White, 23.7% African American, and 23.8% other. RESULTS NAS was identified as a top preferred brand by 15.2% of the participants and was the fourth most popular brand for the sample overall. In a multivariate logistic regression, preference for NAS was significantly greater among participants who were younger (OR=0.97), had some college education or more (OR=2.64 to 4.31), ate a low-fat diet (OR=1.56) and reported better overall health (OR=1.26), with p<0.05. Identifying as Hispanic (OR=1.80) or White (OR=3.00) also predicted NAS preference, p<0.05. NAS preference did not differ by gender or psychiatric diagnosis. CONCLUSIONS Study findings indicate greater NAS brand appeal among smokers living with mental illness who are younger, more highly educated, and have a stronger orientation to health, perhaps because they perceive NAS to be a ‘healthier’ cigarette to smoke. Marketing language that obscures the harms of smoking ought to be prohibited.
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Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Nicole E Anzai
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
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Soyster P, Anzai NE, Fromont SC, Prochaska JJ. Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization. Prev Med 2016; 92:176-182. [PMID: 26892910 PMCID: PMC5108455 DOI: 10.1016/j.ypmed.2016.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.
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Affiliation(s)
- Peter Soyster
- University of California, Berkeley, Department of Psychology. Room 3210, Tolman Hall #1650, Berkeley, CA 94720, USA.
| | - Nicole E Anzai
- Stanford Prevention Research Center, Department of Medicine, Stanford University. 1265 Welch Road, Palo Alto, CA 94305, USA.
| | - Sebastien C Fromont
- Affiliated with Alta Bates Medical Center at the time the study was conducted. 2001 Dwight Way, Berkeley, CA 94704, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University. 1265 Welch Road, Palo Alto, CA 94305, USA.
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Metse AP, Wiggers J, Wye P, Clancy R, Moore L, Adams M, Robinson M, Bowman JA. Uptake of smoking cessation aids by smokers with a mental illness. J Behav Med 2016; 39:876-86. [PMID: 27357297 PMCID: PMC5012253 DOI: 10.1007/s10865-016-9757-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 06/10/2016] [Indexed: 12/13/2022]
Abstract
Psychiatric inpatient settings represent an opportunity to initiate the provision of tobacco cessation care to smokers with a mental illness. This study describes the use of evidence-based smoking cessation aids proactively and universally offered to a population of psychiatric inpatients upon discharge, and explores factors associated with their uptake. Data derived from the conduct of a randomised controlled trial were analysed in terms of the proportion of participants (N = 378) that utilised cessation aids including project delivered telephone smoking cessation counselling and nicotine replacement therapy (NRT), and Quitline support. Factors associated with uptake of cessation aids were explored using multivariable logistic regression analyses. A large proportion of smokers utilised project delivered cessation counselling calls (89 %) and NRT (79 %), while 11 % used the Quitline. The majority accepted more than seven project delivered telephone cessation counselling calls (52 %), and reported NRT use during more than half of their accepted calls (70 %). Older age, higher nicotine dependence, irregular smoking and seeing oneself as a non-smoker were associated with uptake of behavioural cessation aids. Higher nicotine dependence was similarly associated with use of pharmacological aids, as was NRT use whilst an inpatient. Most smokers with a mental illness took up a proactive offer of aids to support their stopping smoking. Consideration by service providers of factors associated with uptake may increase further the proportion of such smokers who use evidence-based cessation aids and consequently quit smoking successfully.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Richard Clancy
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Centre for Translational Neuroscience and Mental Health, Mater Hospital Cnr Edith and Platt Streets, Waratah, NSW, 2298, Australia
| | - Lyndell Moore
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Maree Adams
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Maryanne Robinson
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jenny A Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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