440 likes | 524 Views
The Impact of Smoking Cessation Interventions by Multiple Health Professionals. Lawrence An, MD 1 ; Steven Foldes, PhD 2 ; Nina Alesci, PhD 1 ; Patricia Bland, MA 2 ; Michael Davern, PhD 1 ; Barbara Schillo, PhD 3 ; Jasjit Ahluwalia, MD, MPH 1 ; Marc Manley, MD, MPH 1. University of Minnesota
E N D
The Impact of Smoking Cessation Interventions by Multiple Health Professionals Lawrence An, MD1; Steven Foldes, PhD2; Nina Alesci, PhD1; Patricia Bland, MA2; Michael Davern, PhD1; Barbara Schillo, PhD3; Jasjit Ahluwalia, MD, MPH1; Marc Manley, MD, MPH1 • University of Minnesota • Blue Cross and Blue Shield of Minnesota • Clearway Minnesota
Outline • Background • Research Question • Methods • Results • Implications
Background • 5 A’s for brief intervention include: • Ask about tobacco use • Advise to quit • Assess willingness to make a quit attempt • Assist in quit attempt • Arrange follow-up
Background • Smoking cessation can be effective when provided by physicians or non-physicians • There is a trend toward greater efficacy when intervention is provided by more than one type of health professional • Literature shows suboptimal performance on these measures • Health professionals cite barriers such as time limitations, lack of compensation, and unfamiliarity with treatments
Research Question How do interventions by multiple health providers impact smokers’ quitting behavior?
Research Question • Paper has three goals: • Describe smokers’ reports of cessation interventions by multiple types of health providers
Research Questions • Paper has three goals: • Describe smokers’ reports of cessation interventions by multiple types of health providers • Determine the proportion of smokers who receive interventions by two or more types of health professional
Research Question • Paper has three goals: • Describe smokers’ reports of cessation interventions by multiple types of health providers • Determine the proportion of smokers who receive interventions by two or more types of health professional • Determine how multiple interventions may impact readiness to quit, quit attempts and recent quitting
Methods • Data Source: 2003 Minnesota Adult Tobacco Survey (MATS) • Representative sample of adults in Minnesota and Blue Cross and Blue Shield of Minnesota health plan (total n = 8821) • Survey questions derived from previous tobacco studies, including: • CDC Adult Tobacco Survey • California Tobacco Survey
Methods • Study population: respondents who reported smoking at least 100 cigarettes in their lifetime, including: • Current smokers: individuals who reported smoking “every day” or “some days” • Ex-smokers: individuals not smoking at the time of the survey • Recent ex-smokers: individuals who stopped smoking within the past 12 months
Methods • All survey respondents identified which types of health professionals they had seen in the past 12 months for their own health, including: • Medical doctor • Dentist • Nurse or nurse practitioner • Pharmacist • Other type of health provider
Methods • Current smokers and recent ex-smokers who had seen a health professional answered the following: • “In the past 12 months, did any doctor, nurse or other health professional ask you if you smoke?” • If yes, the type or types of health professionals
Methods • Current smokers also answered the following: • “In the past 12 months, did any doctor, nurse or other health professional advise you to stop smoking?” • Whether health professionals offered assistance, including: • Medications • Setting a quit date • Recommending a cessation program • Offering to schedule a return visit or phone call to help them quit
Methods • Current smokers defined their readiness to quit as one of the following: • Pre-contemplation (not intending to quit in the next 6 months)
Methods • Current smokers defined their readiness to quit as one of the following: • Pre-contemplation (not intending to quit in the next 6 months) • Contemplation (intending to quit in the next 6 months, but not the next 30 days)
Methods • Current smokers defined their readiness to quit as one of the following: • Pre-contemplation (not intending to quit in the next 6 months) • Contemplation (intending to quit in the next 6 months, but not the next 30 days) • Preparation (intending to quit in the next 30 days and having made a quit attempt in the past 12 months)
Methods • Logistic regression analysis using Stata 9.0 complex survey mode • Independent variable: dummy variable representing the level of intervention by health providers • None • One type of health professional • Two or more types of health professionals
Methods • Four separate logistic regression models • All models included: • Demographics (age, gender, ethnicity, education level) • Health status • Number of provider types seen in the past year • Models 2 – 4 also included: • Number of cigarettes smoked each day • Time to first morning cigarette
Methods • Model 1: What is the association between the level of professional intervention and the odds that a patient quit smoking in the past year? • Sample: current smokers and recent ex-smokers • Independent variable: number of types of professionals who Asked about smoking • Dependent variable: smoker quit in past year (Yes or No)
Methods • Model 2: What is the association between the level of professional intervention and the odds that a patient made a quit attempt in the past year? • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker made a quit attempt in past year (Yes or No)
Methods • Model 3: What is the association between the level of professional intervention and the odds that a patient was contemplating making a quit attempt at the time of the survey? • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker reported quit status as contemplation(Yes or No)
Methods • Model 4: What is the association between the level of professional intervention and the odds that a patient was in preparation for a quit attempt at the time of the survey? • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker reported quit status as preparation (Yes or No)
Results • Response rate: 56.5% (n = 8821) • Overall smoking prevalence: 18.0% • Of current smokers and recent ex-smokers (n = 1723): • 59.8% made a quit attempt in the past year • 8.7% no longer smoke
Results SOURCE: 2003 Minnesota Adult Tobacco Survey
Results SOURCE: 2003 Minnesota Adult Tobacco Survey
Results SOURCE: 2003 Minnesota Adult Tobacco Survey
Results Percent of smokers reporting health visits, by type of health professional: 2002-2003 SOURCE: 2003 Minnesota Adult Tobacco Survey
Results • Of current smokers and recent ex-smokers (n = 1723) • 65.5% visited 2 or more types of professional • 24.4% visited 4 or more types of professional • Of those reporting at least one visit (n = 1523) • 34.3% reported that more than one type of professional Asked about smoking
Results Percent of current smokers reporting smoking cessation intervention, by type of health professional: 2002-2003 SOURCE: 2003 Minnesota Adult Tobacco Survey
Results SOURCE: 2003 Minnesota Adult Tobacco Survey
Results • Model 1: Among current smokers and recent ex-smokers, being Asked about smoking by more than one type of professional was significantly associated with quitting in the past year. • Sample: current smokers and recent ex-smokers • Independent variable: number of types of professionals who Asked about smoking • Dependent variable: smoker quit in past year (Yes or No)
Results • Models 2 – 4: Among current smokers only, being Asked about smoking by more than one type of professional was not significantly associated with any of the measured outcomes: • A quit attempt in the past 12 months • Intent to quit in the next 6 months • A plan to quit in the next 30 days
Results • Model 2: Among current smokers only, being Advised to quit by more than one type of professional was significantly associated with an attempt to quit in the past 12 months • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker made a quit attempt in past year (Yes or No)
Results • Model 3: Among current smokers only, being Advised to quit by more than one type of professional was significantly associated with an intent to quit in the next 6 months • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker reported quit status as contemplation(Yes or No)
Results • Model 4: Among current smokers only, there was no significant association between the level of professional intervention and the odds that a patient was in preparation for a quit attempt at the time of the survey • Sample: current smokers only • Independent variables: number of types of professionals who Asked about smoking, Advised to quit, and Assisted the quit attempt • Dependent variable: smoker reported quit status as preparation (Yes or No)
Results • Models 2 – 4: Among current smokers only, being offered Assistance in quitting by more than one type of professional was not significantly associated with any of the measured outcomes: • A quit attempt in the past 12 months • Intent to quit in the next 6 months • A plan to quit in the next 30 days
Results Summary • 65.5% of current smokers and recent ex-smokers reported visiting more than one type of provider in the past year • 34.3% of individuals with visits in the past year reported that more than one type of professional Asked about smoking • Medical doctors and nurses/nurse practitioners were the professionals most cited for asking about tobacco use
Results Summary • Being Asked about smoking by more than one type of health professional was associated with increased odds of successfully quitting in the past year • Being Advised to quit smoking by more than one type of professional was associated with increased odds of a quit attempt or intent to quit
Limitations • Due to the cross-sectional nature of this study, further research is needed to examine issues of causation and confounding factors • Timing of brief interventions and quit attempts • Frequency of visits and interventions • Overall health state and disease progression
Implications • Study supports previous work demonstrating the effectiveness of brief interventions • Increased odds of quitting observed in this study are comparable to other types of tobacco control • Home or workplace bans • Exposure to anti-tobacco media
Implications • Reducing tobacco-related disease is a challenge for all health providers • Activation of professional types across the health care system has the greatest potential to increase quitting and readiness to quit among smokers