Does it matter who you see to help you stop smoking? Short-term quit rates across specialist stop smoking practitioners in England.
ABSTRACT A network of Stop Smoking Services has been set up within the National Health Service (NHS) in England. The services deliver a combination of behavioural support and medication. It is important to establish the degree of variability in quit rates attributable to differences between individual practitioners, to gauge the scope for improvement by training and professional support. The aim of the present analysis was to examine how far short-term quit rates depend on the practitioner delivering the intervention after adjusting for potential confounding variables.
Observational study using routinely collected data.
Thirty-one NHS Stop Smoking Services in England.
Data from 46 237 one-to-one treatment episodes (supported quit attempts) delivered by specialist practitioners.
Three-level logistic regression models were fitted for carbon monoxide (CO)-validated short-term (4-week) quit rates. Models adjusted for age, gender, exemption from prescription charges, medication and intervention setting for each treatment episode, number of clients for each practitioner and economic deprivation at the level of the Stop Smoking Service. Secondary analyses included (i) the Heaviness-of-Smoking Index (HSI) as predictor and (ii) 4-week quit rates whether or not confirmed by CO.
Differences between individual specialist practitioners explained 7.6% of the variance in CO-verified quit rates after adjusting for client demographics, intervention characteristics and practitioner and service variables (P < 0.001). HSI had little impact on this figure; in quits not necessarily validated by CO, practitioners explained less variance.
Individual stop smoking practitioners appear to differ to a significant degree in effectiveness. It is important to examine what underlies these differences in order to improve selection, training and professional development.
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ABSTRACT: INTRODUCTION: Behavioral support improves smokers' chances of quitting, but quit rates are typically lower for smokers supported by "community practitioners" for whom smoking cessation is a small part of their job than for those supported by "specialist practitioners" for whom it is the main role. This article examined the factors that might contribute to this. METHOD: A total of 573 specialist practitioners and 466 community practitioners completed a 42-item online survey that covered demographic and employment information, current practices, levels of training, and 4-week CO-verified quit rates. Responses were compared for community and specialist practitioners. Mediation analysis was undertaken to assess how far "structural" and "modifiable" variables account for the difference in quit rates. RESULTS: Specialist practitioners reported higher 4-week CO-verified quit rates than community practitioners (63.6% versus 50.4%, p < .001). Practitioners also differed significantly in employment variables, evidence-based practices, and levels of training. Six "modifiable" variables (proportion of clients using an "abrupt" quit model, duration of first session, always advising on medications, number of days training received, number of sessions observed when starting work, and number of sessions having been observed in practice and received feedback) mediated the association between practitioners' role and quit rates over and above the "structural" variables, explaining 14.3%-35.7% of the variance in the total effect. CONCLUSIONS: "Specialist" practitioners in the English stop-smoking services report higher success rates than "community" practitioners and this is at least in part attributable to more extensive training and supervision and greater adherence to evidence-based practice including advising on medication usage and promoting abrupt rather than gradual quitting.Nicotine & Tobacco Research 12/2012; · 2.48 Impact Factor
- The British journal of psychiatry: the journal of mental science 01/2013; 202:74-5. · 6.62 Impact Factor
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ABSTRACT: BACKGROUND AND AIMS: Cross-study comparisons of effect sizes suggest that varenicline is more effective than nicotine replacement therapy (NRT) in aiding smoking cessation, but evidence from direct comparisons is limited. This study compared biochemically verified 52-week sustained abstinence rates in smokers attending the same clinical service according to whether they used varenicline or NRT in their quit attempt. METHODS: This was a prospective cohort study of 855 smokers attending a large smoking cessation clinic who used their choice of NRT product or varenicline in their quit attempt. All received the same behavioural support programme and chose their medication option (n = 519 varenicline; n = 336 NRT). The primary outcome measure was self-report of 52 weeks' abstinence following the target quit date confirmed by expired air carbon monoxide concentration. Baseline measures included socio-demographic variables, mental health diagnoses, measures of smoking, cigarette dependence and past use of NRT or varenicline. RESULTS: The 52-week abstinence rates were 42.8% versus 31.0% in those using varenicline versus NRT, respectively (P < 0.001). After adjusting for all baseline variables, the odds of remaining abstinent for 52 weeks were 2.03 (95% CI 1.46-2.82), P < 0.001 times higher in those using varenicline than those using NRT. CONCLUSIONS: Smokers in the same behavioural support programme who use varenicline appear to have a greater probability of achieving long-term abstinence than those using their choice of nicotine replacement therapy options, even after adjusting for potentially confounding smoker characteristics.Addiction 05/2013; · 4.58 Impact Factor