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E of computer-tailored S moking C essation A dvice in P rimary car E A Randomised Controlled Trial. ffectiveness. Hazel Gilbert Department of Primary Care and Population Sciences UCL . Smoking Cessation Interventions. Clinical approach Intensive face-to-face Relatively high quit rates

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Eof computer-tailoredSmokingCessationAdviceinPrimarycarE

A Randomised Controlled Trial

ffectiveness

Hazel Gilbert

Department of Primary Care and Population Sciences

UCL


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Smoking Cessation Interventions

  • Clinical approach

  • Intensive face-to-face

  • Relatively high quit rates

  • Low participation rates

  • Unrepresentative

  • Public health campaigns

    • Large-scale programs

    • Impersonal

    • High reach

    • Low quit rates


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NHS Smoking Cessation Service

Longer term data collected from two PCTs

Oct 2001 to March 2003

  • 4 week abstinence 53%

  • 52 week abstinence 15%

  • consistent with published studies

  • Low participation rates

    • 6% of smokers use the services per year

    • 1% of smokers are helped to stop long-term


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    Challenges for Primary Care

    • To increase success rates in clinics

    • Reach the smokers who do not use clinics


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    Self-help Materials

    • Generic leaflets and manuals

    • Personalised generic

    • Targeted materials to particular groups

    • Individually Tailored Feedback

      Definition: ‘intended to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment’

      (Kreuter et al 1999)


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    Proactiverecruitment

    • Contact individuals directly offering a service

    • Higher participation

    • More demographically representative

    Escape trial is proactively recruiting smokers by sending questionnaires to a large population group using GP records


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    Tailored feedback+Proactive Recruitment

    behavioural intervention principles of the clinical approach

    participation rates of public health campaigns

    provide personal, individually tailored self-help reports for a large population of smokers


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    Targeting specific population groups

    • Smokers not motivated to quit

    • Areas of high deprivation where smoking prevalence is higher

  • Primary Care Networks can help us to target these specific population groups and achieve the objectives


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    Practice Recruitment

    • Aimed to recruit 100 MRC GPRF practices, representing high and low socio-economic areas

    • 116 expressed an interest in the study

    • Ranked practice postcodes from least to most deprived by Carstairs scores

    • Allocated to deprivation quintiles

    • Selected proportionally from each quintile


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    Participant Recruitment

    • Practices identify current cigarette smokers aged 18 to 65 from records using the computer system

    • Randomly select a sample of 520

    • List screened by GP to exclude patients not appropriate e.g. terminal illness

    • Smokers (n=50,000) sent the Smoking Behaviour Questionnaire together with a covering letter from GP

    Estimate a response rate of 15% from 2 mailings (reminder and duplicate SBQ) to secure 7250 participants



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    General

    Practice

    Research

    Framework

    Co-investigators

    Professor Irwin Nazareth

    Dr Richard Morris

    Department of Primary Care and Population Sciences, UCL

    Professor Stephen Sutton

    Institute of Public Health, University of Cambridge

    Professor Christine Godfrey

    Department of Health Sciences, University of York




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    Aim

    To examine the effect of computer generated individually tailored feedback reports designed to help and encourage smokers to quit, on quit rates and quitting activity, when sent to smokers with varying levels of motivation and reading ability, identified from GP lists



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    The Trial Interventions

    • Participants return the questionnaire to the research team at UCL. Randomly allocated to either:

      Control Group

      • Standard booklet

      • Usual care offered by the practice

  • Intervention Group

    • Standard booklet

    • Usual care offered by general practice

    • Computer-tailored feedback report

    • Additional assessment and feedback report one month after baseline received

  • Smoking status, cognitive change, adherence to advice, perceptions of the feedback reports, and economic issues assessed by postal questionnaire at a 6-month follow-up


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    Expected outcomes

    • Simple and inexpensive intervention 

    • Low-cost, high-reach approach that can complement and extend the brief advice given by GPs

    • Enable the standardised collection of relevant information by practice nurses or other health professionals, and can be used to structure and reinforce the advice given

    • Could offer an efficient tool to integrate smoking cessation counselling into a busy primary care practice


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    Why do we need research into smoking cessation?

    • Leading preventable cause of disease and death

    • Smoking is a modifiable behaviour

    • Approximately 25% of the population still smoke




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