Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

BACKGROUND

The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.

METHODS

An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.

RESULTS

Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.

CONCLUSIONS

Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

A 'Cut-Down-To-Stop' intervention for smokers who find it hard to quit: a qualitative evaluation

Background

English Stop Smoking Services primarily deliver behavioural interventions to support abrupt quit attempts. Recent evidence suggests an alternative approach could be offered to clients involving a more gradual reduction of cigarettes smoked leading to complete abstinence, known as ‘Cut Down To Stop’ (CDTS). The purpose of this study was to explore the experiences of stop smoking practitioners and service users who participated in a pilot study of a CDTS service.

Methods

The CDTS intervention was pilot tested in a Stop Smoking Service in London, England. As part of the CDTS intervention clients who were still smoking 2 weeks after their quit date were offered tailored advice, medication and support to reduce their current smoking by half, with the aim to stop smoking altogether within a six-month period. A qualitative evaluation was conducted involving a focus group discussion with nine practitioners involved in the delivery of the CDTS intervention and telephone interviews with 18 CDTS service users. Thematic analysis was performed.

Results

Service users and practitioners were very positive about their experience with the CDTS intervention. The intervention was found to be an effective way of keeping clients engaged with the service and was felt to increase the likelihood they might quit and/or re-engage in service for future quit attempts. Elements that contributed to the attractiveness of the CDTS intervention included: 1) the trust and empathetic relationship developed between service users, practitioners and their referring primary care provider; 2) time and flexibility for service users to engage in the quitting process at their own pace; 3) setting progressive goals and building service user confidence; 4) the opportunity to experiment with quit smoking medications; and, 5) the on-going contact with the practitioner/service.

Conclusions

Service users who are not successful with quitting abruptly may benefit from a CDTS intervention. This study highlights the important role of ‘relationships’, time and ‘flexible’ service delivery models in engaging service users who are not initially successful with quitting. The findings of this study have the potential to inform decision-making regarding the value of the CDTS approach for the English Stop Smoking Service and cessation services worldwide.

Translating evidence-based guidelines into practice: a survey of practices of commissioners and managers of the English stop smoking services

Background

The English National Health Service’s (NHS) Stop Smoking Services (SSSs) constitute one of the most highly developed behavioural support programmes in the world. However, there is significant variation in success rates across the approximately 150 services, some of which may be due to variation in practice. This study aimed to assess these differences in practice.

Methods

Two online surveys were administered. All commissioners (people who purchase services for the NHS) and managers (those who run the services) of NHS SSSs in England were invited to participate. Items included details of current practices and services provided, what informed the commissioning of SSSs, what targets were included within service specifications and whether the types of treatment model to be delivered were specified.

Results

Both surveys had a response rate of 35%, with 50 commissioners and 58 managers participating. There were no significant differences between the characteristics of the Primary Care Trusts (PCTs) from which commissioners and managers responded to this survey and those PCTs from which there was no response. Managers reported that the treatment model most frequently offered by SSSs was one-to-one (98%). A total of 16% of managers reported that some approved medications were not available as first-line treatments. Just over one third (38%) of commissioners reported consulting national guidelines or best evidence to inform local commissioning. Almost one third (30%) of commissioners reported that they specified the types of stop smoking interventions to be delivered by the providers.

Conclusions

A substantial part of commissioning of Stop Smoking Services in England appears to take place without adequate consultation of evidence-based guidelines or specification of the service to be provided. This may account for at least some of the variation in success rates.

Preventing smoking relapse using text messages: analysis of data from the txt2stop trial

INTRODUCTION

Interactive text message-based technologies which operate in real time have the potential to be especially effective for delivery of relapse prevention interventions. We examined predictors of use of a text message system for providing support for lapses and cravings, describe the natural history of requests for support, and predictors of time to requests for support.

METHODS

Data were collected prospectively from participants in the intervention arm of txt2stop, a large randomized controlled trial of an automated, text message-based smoking cessation intervention. Txt2stop included 2,915 men and women aged 16-78, recruited from London, United Kingdom from 2009 to 2010. Participants could text "crave" or "lapse" when they experienced either; an automated system registered the time of the text message to the nearest second.

RESULTS

One thousand one hundred and twenty one (38.5%) participants sent a lapse or crave message to request support. Women were more likely to lapse at some point during the trial. Of those who lapsed, being female, younger age, and setting a Saturday quit date were predictors of sending a lapse text requesting support. Half of all crave texts arrived within 106 hr of quitting. Half of all lapse texts arrived between 4 and 17 days after the quit date. Sending a crave text, being female, younger, and setting a quit date on a Saturday were associated with shorter time to sending a first lapse text.

CONCLUSIONS

Text-based lapse support should be developed and evaluated, especially for women. Smokers may benefit from additional support to prevent lapses on days 4-17 postquit attempt.

Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking Services

The primary aim of the current study is to investigate the self-reported practices, attitudes and levels of training of stop smoking practitioners (SSPs) working at the English National Health Service's (NHS) Stop Smoking Services (SSSs). A secondary aim was to investigate differences between 'Specialist' and 'Community' SSPs. An online survey was conducted with 484 SSPs. Most (94%) SSPs offered one-to-one appointments to smokers, only 43% always used the abrupt quit model and 30% reported ever recommending particular medication to clients. SSPs reported an average of 3.7 days training when starting work and 26% reported never observing an experienced practitioner before seeing clients of their own. Over half (56%) never received clinical supervision. SSPs reported having generally positive attitudes towards their jobs, but reported feeling less positive about their prospects for future employment within the field. 'Specialist' SSPs reported receiving more days training (4.1 vs. 3.0, p=0.002), more days observing an experienced practitioner when starting work (12.9 vs. 6.6, p<0.001) and were more likely to receive clinical supervision (48.9% vs. 34.9%, p<0.05) than 'Community' SSPs. Gaps between SSPs' current practices and evidence-based guidelines may be due to inadequate training. Similarly, differences in training between specialist and community SSPs may contribute to the observed difference in these practitioners' success rates. As recommended by the Department of Health for England, standardized training in evidence-based smoking cessation interventions should be implemented for both specialist and community SSPs.