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Who are smoking cessation services in Scotland reaching? A secondary analysis of routine data

Who are smoking cessation services in Scotland reaching? A secondary analysis of routine data. Jan Kerssens, Cheryl Denny, Linsey Galbraith (ISD) Sally Haw, Linda Bauld (Stirling University ) Rosemary Hiscock (University of Bath). Outline. Scotland Smoking Cessation services Data set

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Who are smoking cessation services in Scotland reaching? A secondary analysis of routine data

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  1. Who are smoking cessation services in Scotland reaching? A secondary analysis of routine data Jan Kerssens, Cheryl Denny, Linsey Galbraith (ISD) Sally Haw, Linda Bauld (Stirling University ) Rosemary Hiscock (University of Bath)

  2. Outline • Scotland • Smoking Cessation services • Data set • Interventions • Client groups • Standardised Rates • Funnel plots • Conclusion • Questions

  3. Scotland • Northern part of UK mainland • Just over 5 million inhabitants, concentrated in the central belt • Edinburgh capital – Glasgow biggest city – 32 Local authorities (councils) • Islands in the west and the north • Health inequalities • 24% smokers (top 6 in Europe)

  4. Smoking prevalence

  5. Smoking cessation services • 14 geographical NHS Health Boards • 32 Local authorities (councils) • 40 Community health partnerships • 4 in Highlands; 3 in Fife; 5 in Glasgow • Rest coterminous with Local authorities • Pharmacy, General practice, Specialist setting • Nicotine Replacement Therapy (NRT), Varenicline, Group support

  6. The national database NHSNet connection Server at ISD NHS board staff ISD analysis (no access to person-identifying data) Data from GG & C

  7. Client information • Age • Sex • Pregnancy • Ethnic background • Free prescriptions • Employment status • Postcode

  8. Tobacco use and Interventions • Quit date • Pharmaceutical usage • Behavioural support • Intervention setting • Free prescriptions • Follow-up

  9. Outcomes • Success/failure • 3-month follow-up • 12-month follow-up

  10. Pharmacy • Over 130,000 quit attempts made in 2010-2011 • Broadly, the more deprived the area a client is from, the more chance the client will using a pharmacy service • Most popular in 18-34 yr age group and least popular with those aged 60+ • Unemployed most likely to use pharmacy service while sick or disabled least likely to

  11. NRT • Variation of Nicotine Replacement Therapy use across NHS boards from 60% to over 90%

  12. Varenicline • Variation of Varenicline use across NHS boards from less than 10% to 34% of all quit attempts made Legend Quit attempt using Varenicline (%)

  13. Other features of different pharmacotherapy users • Those in paid employment, full-time parents and permanently sick/disabled use Varenicline more than any other employment groups • Students and the unemployed use Varenicline the least • Proportionally, more 45-59 year olds used Varenicline than any other age group (and used NRT the least) while the lowest use of Varenicline was in the younger age groups (e.g. 18-24). • No difference in prescribing by sex (approx. 75% NRT and 10-11% Varenicline) • By deprivation: broadly similar percentages of each deprivation group being prescribed Varenicline (around 19%). Lowest in least deprived (14%)

  14. Group Support • Around 30,000 quit attempts made in 2010-2011 with group support • The more deprived the area a client is from, the less chance the client will use group intervention. 30% - 5% • Most popular in <18s and 45-59 age groups (23%) and lowest in those aged 18-34 (14-17%). • Highest uptake in homemakers, the employed and sick/disabled (22-25%). Lowest in unemployed (11%).

  15. 2- years reach

  16. Percentage and Standardised Rates N=192,194

  17. Standardised Rates (SR) • Indirect standardised rates for each service • For example, when 88% of men undertook a quit attempt in pharmacy (numerator) • And 80% of all the quit attempt in were in pharmacy (denimonator) • The SR is then 88/80 = 1.10 for men in pharmacy in that service • Over-representation of 10% • Rates suppressed when numerator < 5 and/or denomiator < 30 • Difference with Scotland’s SR (+/- 3 SD)

  18. A funnel plot is a graph with a performance indicator on the vertical-axis and the number of observations on the horizontal-axis

  19. A data point is added for each service…

  20. Scotland’s SR is added as a horizontal line...

  21. Control limits are added, assuming that the services differ by chance only…

  22. Young age and group support

  23. Results/Conclusion • The reach for some services showed gaps for young people in • Providing multiple product NRT (13 out of 40) • Providing varenicline (13 out of 37) • Group support (19 out of 34) • The reach for some services showed gaps for people in most deprived areas • Quit attempts in pharmacy (14 out of 40) • Very few gaps were found for men and women • Pregnancy too many small numbers • Using Standardised Rates for smoking cessation interventions seems to offer a useful frame work for analysing service reach

  24. Questions …

  25. Reach and Outcome • Absolute and relative numbers of successful quit attempts • Outcome varies from 27% to 55% (Scotland 38%) • Reach varies from 6% to 29% (Scotland 18%) • Success in terms of • High success rate / low volume • Low success rate / high volume • Success per 100 smokers

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