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Minué-Lorenzo C, Olano-Espinosa E, Minué-Estirado M, Vizcaíno-Sánchez JM, Camarelles-Guillem F, Granados-Garrido JA, Ruiz-Pacheco M, Gámez-Cabero MI, Martínez-Suberviola FJ, Serrano-Serrano E, Cura-González ID. Gender, smoking, and tobacco cessation with pharmacological treatment in a cluster randomized clinical trial. Tob Induc Dis 2024; 22:TID-22-38. [PMID: 38362269 PMCID: PMC10867739 DOI: 10.18332/tid/177260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.
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Affiliation(s)
- César Minué-Lorenzo
- Centro de Salud Perales del Río, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, España
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Research Network on Preventive Activities and Health Promotion, Madrid, Spain
| | - Eduardo Olano-Espinosa
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Research Network on Preventive Activities and Health Promotion, Madrid, Spain
- Centro de Salud Los Castillos, Dirección Asistencial Oeste, Servicio Madrileño de Salud, Madrid, España
| | - María Minué-Estirado
- Centro de Salud José María Llanos, Dirección Asistencial Este, Servicio Madrileño de Salud, Madrid, España
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Jose-María Vizcaíno-Sánchez
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Centro de Salud Fuentelarreina, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, España
| | - Francisco Camarelles-Guillem
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Research Network on Preventive Activities and Health Promotion, Madrid, Spain
- Centro de Salud Infanta Mercedes, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, España
| | - José-Antonio Granados-Garrido
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Research Network on Preventive Activities and Health Promotion, Madrid, Spain
- Centro de Salud Guayaba, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, España
| | - Margarita Ruiz-Pacheco
- Centro de Salud Algete, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, España
| | - María Isabel Gámez-Cabero
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Centro de Salud Majadahonda Valle de la Oliva, Dirección Asistencial Noroeste, Servicio Madrileño de Salud, Madrid, España
| | - Francisco Javier Martínez-Suberviola
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Centro de Salud Guayaba, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, España
| | - Encarnación Serrano-Serrano
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Hospital Doce de Octubre (i+12), Madrid, España
- Research Network on Preventive Activities and Health Promotion, Madrid, Spain
- Centro de Salud Los Fresnos, Dirección Asistencial Este, Servicio Madrileño de Salud, Madrid, España
| | - Isabel Del Cura-González
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Madrid, España
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
- Red de Investigación Servicios de Salud en enfermedades crónicas, REDISSEC, Madrid, España
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Olano-Espinosa E, Avila-Tomas JF, Minue-Lorenzo C, Matilla-Pardo B, Serrano Serrano ME, Martinez-Suberviola FJ, Gil-Conesa M, Del Cura-González I. Effectiveness of a Conversational Chatbot (Dejal@bot) for the Adult Population to Quit Smoking: Pragmatic, Multicenter, Controlled, Randomized Clinical Trial in Primary Care. JMIR Mhealth Uhealth 2022; 10:e34273. [PMID: 35759328 PMCID: PMC9274388 DOI: 10.2196/34273] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/20/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. Objective This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. Methods This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A’s (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. Results The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). Conclusions A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. Trial Registration Clinicaltrials.gov NCT 03445507; https://tinyurl.com/mrnfcmtd International Registered Report Identifier (IRRID) RR2-10.1186/s12911-019-0972-z
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Affiliation(s)
| | - Jose Francisco Avila-Tomas
- Healthcare Center Santa Isabel, Madrid Health Service, Leganes, Spain
- Preventive Medicine and Public Health Department, Rey Juan Carlos University, Alcorcon, Spain
| | | | | | | | | | - Mario Gil-Conesa
- Preventive Medicine Service, Hospital Universitario Fundación Alcorcón, Madrid Health Service, Madrid, Spain
| | - Isabel Del Cura-González
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Research Network on Health Services in Chronic Diseases, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database Syst Rev 2021; 9:CD011556. [PMID: 34693994 PMCID: PMC8543670 DOI: 10.1002/14651858.cd011556.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care is an important setting in which to treat tobacco addiction. However, the rates at which providers address smoking cessation and the success of that support vary. Strategies can be implemented to improve and increase the delivery of smoking cessation support (e.g. through provider training), and to increase the amount and breadth of support given to people who smoke (e.g. through additional counseling or tailored printed materials). OBJECTIVES To assess the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings. To assess whether any effect that these interventions have on smoking cessation may be due to increased implementation by healthcare providers. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries to 10 September 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs (cRCTs) carried out in primary care, including non-pregnant adults. Studies investigated a strategy or strategies to improve the implementation or success of smoking cessation treatment in primary care. These strategies could include interventions designed to increase or enhance the quality of existing support, or smoking cessation interventions offered in addition to standard care (adjunctive interventions). Intervention strategies had to be tested in addition to and in comparison with standard care, or in addition to other active intervention strategies if the effect of an individual strategy could be isolated. Standard care typically incorporates physician-delivered brief behavioral support, and an offer of smoking cessation medication, but differs across studies. Studies had to measure smoking abstinence at six months' follow-up or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our primary outcome - smoking abstinence - was measured using the most rigorous intention-to-treat definition available. We also extracted outcome data for quit attempts, and the following markers of healthcare provider performance: asking about smoking status; advising on cessation; assessment of participant readiness to quit; assisting with cessation; arranging follow-up for smoking participants. Where more than one study investigated the same strategy or set of strategies, and measured the same outcome, we conducted meta-analyses using Mantel-Haenszel random-effects methods to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS We included 81 RCTs and cRCTs, involving 112,159 participants. Fourteen were rated at low risk of bias, 44 at high risk, and the remainder at unclear risk. We identified moderate-certainty evidence, limited by inconsistency, that the provision of adjunctive counseling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost-free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. There was also moderate-certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow-up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants). There was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies we judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty. We downgraded the evidence due to imprecision, inconsistency and risk of bias across these comparisons. There was some indication that provider training increased the delivery of smoking cessation support, along with the provision of adjunctive counseling and cost-free medications. However, our secondary outcomes were not measured consistently, and in many cases analyses were subject to substantial statistical heterogeneity, imprecision, or both, making it difficult to draw conclusions. Thirty-four studies investigated multicomponent interventions to improve smoking cessation rates. There was substantial variation in the combinations of strategies tested, and the resulting individual study effect estimates, precluding meta-analyses in most cases. Meta-analyses provided some evidence that adjunctive counseling combined with either cost-free medications or provider training enhanced quit rates when compared with standard care alone. However, analyses were limited by small numbers of events, high statistical heterogeneity, and studies at high risk of bias. Analyses looking at the effects of combining provider training with flow sheets to aid physician decision-making, and with outreach facilitation, found no clear evidence that these combinations increased quit rates; however, analyses were limited by imprecision, and there was some indication that these approaches did improve some forms of provider implementation. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing adjunctive counseling by an allied health professional, cost-free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. There is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, we rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. Further studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting. Such studies should be cluster-randomized to account for the implications of implementation in this particular setting. Due to substantial variation between studies in this review, identifying optimal characteristics of multicomponent interventions to improve the delivery of smoking cessation treatment was challenging. Future research could use component network meta-analysis to investigate this further.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gillian Pritchard
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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González-Roz A, Weidberg S, García-Pérez Á, Martínez-Loredo V, Secades-Villa R. One-Year Efficacy and Incremental Cost-effectiveness of Contingency Management for Cigarette Smokers With Depression. Nicotine Tob Res 2021; 23:320-326. [PMID: 32772097 DOI: 10.1093/ntr/ntaa146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Contingency management (CM) is efficacious for smoking cessation. To date, the number of cost-effectiveness evaluations of behavioral and pharmacological smoking cessation treatments far outnumbers the ones on CM. This study estimated 1-year efficacy and incremental cost-effectiveness of adding CM in relation to abstinence outcomes for a cognitive-behavioral therapy (CBT)+behavioral activation (BA) treatment. METHODS The study sample comprised 120 smokers with depression (% females: 70.8%; mean age: 51.67 [SD = 9.59]) enrolled in an 8-week randomized controlled clinical trial. Clinical effectiveness variables were point-prevalence abstinence, continuous abstinence, longest duration of abstinence (LDA), and Beck-Depression Inventory-II (BDI-II) scores at 1-year follow-up. Cost-effectiveness analyses were based on resource utilization, unit costs per patient, and incremental cost per additional LDA week at 1 year. RESULTS There was a significant effect of time by treatment group interaction, which indicated superior effects of CBT+BA+CM across time. Point-prevalence abstinence (53.3% [32/60]) was superior in participants receiving CBT+BA+CM compared with those in CBT+BA (23.3% [14/60]), but both groups were equally likely to present sustained reductions in depression. The average cost per patient was €208.85 (US$236.57) for CBT+BA and €410.64 (US$465.14) for CBT+BA+CM, p < .001. The incremental cost of using CM to enhance 1-year abstinence by one extra LDA week was €18 (US$20.39) (95% confidence interval: 17.75-18.25). CONCLUSIONS Behavioral treatments addressing both smoking and depression are efficacious for sustaining high quit rates at 1 year. Adding CM to CBT+BA for smoking cessation is highly cost-effective, with an estimated net benefit of €4704 (US$5344.80). IMPLICATIONS Informing on the cost-effectiveness of CM might expedite the translation of research findings into clinical practice. Findings suggested that CM is feasible and highly cost-effective, confirming that its implementation is worthwhile. At a CM cost per patient of €410.64 (US$465.14), the net benefit equals €4704 (US$5344.80), although even starting from a minimum investment of €20 (US$22.72) was cost-effective. CLINICALTRIALS-GOV IDENTIFIER NCT03163056.
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Affiliation(s)
- Alba González-Roz
- Department of Psychology, University of Oviedo, Plaza Feijóo s/n, Oviedo, Spain
| | - Sara Weidberg
- Department of Psychology, University of Oviedo, Plaza Feijóo s/n, Oviedo, Spain
| | - Ángel García-Pérez
- Department of Psychology, University of Oviedo, Plaza Feijóo s/n, Oviedo, Spain
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Cobos-Campos R, Mar J, Apiñaniz A, de Lafuente AS, Parraza N, Aizpuru F, Orive G. Cost-effectiveness analysis of text messaging to support health advice for smoking cessation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:9. [PMID: 33588885 PMCID: PMC7885425 DOI: 10.1186/s12962-021-00262-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.
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Affiliation(s)
- Raquel Cobos-Campos
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain.
| | - Javier Mar
- Osakidetza Basque Health Service, Primary Care Research Unit of Gipuzkoa, Alto Deba Hospital, Arrasate-Mondragón, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Antxon Apiñaniz
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Lakuabizkarra Health Centre, Vitoria-Gasteiz, Spain
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Arantza Sáez de Lafuente
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Naiara Parraza
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Felipe Aizpuru
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Subdirectorate of Health Care, Vitoria-Gasteiz, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Vitoria-Gasteiz, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
- Bioaraba Health Research Institute, Nanobiocel Research group, Vitoria-Gasteiz, Spain.
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain.
- Singapore Eye Research Institute, Singapore, Singapore.
- CIBER Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, Madrid, Spain.
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Girvalaki C, Papadakis S, Mechili EA, Nikitara K, Demin A, Trofor AC, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakhturidze G, Ayesta J, Przewoźniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries. Tob Induc Dis 2020; 18:40. [PMID: 32435174 PMCID: PMC7233524 DOI: 10.18332/tid/120188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, Greece
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Pristina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewoźniak
- Foundation ‘Smart Health – Health in 3D’, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Società Italiana di Tabaccologia (SITAB), Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Public Health, Environment and Tobacco Control, Maribor, Slovenia
| | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanović Batut’, Belgrade, Serbia
| | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece
- Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
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Avila-Tomas JF, Olano-Espinosa E, Minué-Lorenzo C, Martinez-Suberbiola FJ, Matilla-Pardo B, Serrano-Serrano ME, Escortell-Mayor E. Effectiveness of a chat-bot for the adult population to quit smoking: protocol of a pragmatic clinical trial in primary care (Dejal@). BMC Med Inform Decis Mak 2019; 19:249. [PMID: 31796061 PMCID: PMC6889580 DOI: 10.1186/s12911-019-0972-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The wide scale and severity of consequences of tobacco use, benefits derived from cessation, low rates of intervention by healthcare professionals, and new opportunities stemming from novel communications technologies are the main factors motivating this project. Thus, the purpose of this study is to assess the effectiveness of an intervention that helps people cease smoking and increase their nicotine abstinence rates in the long term via a chat-bot, compared to usual practice, utilizing a chemical validation at 6 months. METHODS Design: Randomized, controlled, multicentric, pragmatic clinical trial, with a 6-month follow-up. SETTING Healthcare centers in the public healthcare system of the Community of Madrid (Madrid Regional Health Service). PARTICIPANTS Smokers > 18 years of age who attend a healthcare center and accept help to quit smoking in the following month. N = 460 smokers (230 per arm) who will be recruited prior to randomization. Intervention group: use of a chat-bot with evidence-based contents to help quit smoking. CONTROL GROUP Usual treatment (according to the protocol for tobacco cessation by the Madrid Regional Health Service Main variable: Continuous nicotine withdrawal with chemical validation (carbon monoxide in exhaled air). Intention-to-treat analysis. Difference between groups in continuous abstinence rates at 6 months with their corresponding 95% confidence interval. A logistic regression model will be built to adjust for confounding factors. RESULTS First expected results in January 2020. DISCUSSION Providing science-based evidence on the effectiveness of clinical interventions via information technologies, without the physical presence of a professional, is essential. In addition to being more efficient, the characteristics of these interventions can improve effectiveness, accessibility, and adherence to treatment. From an ethics perspective, this new type of intervention must be backed by scientific evidence to circumvent pressures from the market or particular interests, improve patient safety, and follow the standards of correct practices for clinical interventions. TRIAL REGISTRATION ClinicalTrials.gov, reference number NCT03445507.
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Affiliation(s)
- J F Avila-Tomas
- Universidad Rey Juan Carlos, Madrid, Spain.
- Healthcare center Sta. Isabel, Madrid Regional Health Service, 28911, Leganés, Madrid, Spain.
| | - E Olano-Espinosa
- Healthcare center Los Castillos, DAO, Madrid Regional Health Service, Alcorcón, Madrid, Spain
| | - C Minué-Lorenzo
- Healthcare center Perales del Río, DAC, Madrid Regional Health Service, Getafe, Madrid, Spain
| | | | - B Matilla-Pardo
- Healthcare center Panaderas, DAO, Madrid Regional Health Service, Fuenlabrada, Madrid, Spain
| | - M E Serrano-Serrano
- Healthcare center Los Fresnos, DAE, Madrid Regional Health Service, Torrejón de Ardoz, Madrid, Spain
| | - E Escortell-Mayor
- Gerencia Asistencial de Atención Primaria (GAAP), Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
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