Eof computertailored Smoking Cessation Advice in Primary carE

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Developing tailored interventions for smoking
cessation in primary care the background to the
ESCAPE trial
Hazel Gilbert, Irwin Nazareth and Richard
Morris Department of Primary Care and Population
Sciences, UCL Stephen Sutton Institute of
Public Health, University of Cambridge
ffectiveness
Eof computer-tailored Smoking Cessation Advice in
Primary carE
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ESCAPE The Aim
To examine the effect of computer-generated
individually tailored feedback reports 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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ESCAPE The Background

• Smoking is the leading preventable cause of
  disease and death
• Smoking is a modifiable behaviour
• Intensive face-to-face or group therapy most
  effective treatment

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• NHS Smoking Cessation Service
• Low participation rates
• 6 of smokers use the services per year
• 97 one to one / 3 groups
• Relatively high quit rates
• 52 week abstinence rate 15
• 1 of smokers helped to stop long-term

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• Challenges for Primary Care
• To increase success rates in clinics
• Bridge the gap between clinical and public health
  approach
• Reach the smokers who do not use clinics

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• Self help Materials
• Generic leaflets and manuals
• Targeted materials to particular groups
• Individually tailored feedback defined as
• 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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Feasibility of and response rates to proactive
recruitment in general practice
Characteristics of respondents

• Response from practices encouraging
• Range of list sizes (6400 to 16000)
• Range of levels of deprivation
• of identified smokers 8-23
• Corresponds with deprivation scores
• Mean response rate 8.9
• Mean 3-month follow-up response rate 66.7

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Focus groups to assess perception and reaction to
computer tailored feedback
Females  Yes, if I had got one of these,
something tailored to what I said on my
questionnaire, I would have been quite pleased,
something just for me. They are actually
bothering with me and, because I have sent in the
questionnaire, you actually want me to quit. You
know what I mean, I think it is pretty good.
I think the best thing is that it is aimed at
an individual unlike the leaflets which are an
overall thing.
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Males   There is a strong reassurance, its an
expression of support. I like the basic concept,
I like the idea of a tailored letter in response
to a questionnaire, I like the idea of having
that sort of personal support.  ----- It looks
like a chain letter even though it is trying not
to be. Yes it looks a bit like a template
thats just been printed off. You know, once I
have written a questionnaire saying I am giving
up, I am giving up for health reasons, I dont
really need to be told that smoking is dangerous
for you.   (If) I opened and I saw all that
writing, you know I would, it would go in the
bin. It needs more pictures, it needs to be
more, like, more grabbing to you, so that you
want to read it.
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ESCAPE - Recruitment

• recruit 100 MRC GPRF practices, selected to
  represent high and low socio-economic areas
• each practice select a random sample of 500
  current cigarette smokers, aged between 18 and 65
• selected patients (n50,000) sent the Smoking
  Behaviour Questionnaire (SBQ), together with a
  covering letter from their GP
• an estimated response rate of 15 from 2 mailings
  (reminder and duplicate SBQ) will secure 7250
  participants

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ESCAPE - Trial Interventions

• Questionnaires returned to research team at UCL
• Participants randomly allocated to
• Control Group
• standard NHS Giving up for life booklet
• the usual care offered by general practice
• Intervention Group
• computer-tailored feedback report
• additional one month assessment and feedback
  report

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ESCAPE Outcome Measures

• 6 month follow-up questionnaire
• Primary
• prolonged abstinence for 1 and 3 months
• Secondary
• 24hr and 7 day point-prevalence abstinence
• quit attempts
• changes in motivation, intention to quit,
  cognitions
• use of NRT or Zyban
• contact with advice services or health
  professionals
• Process
• adherence to advice
• perceptions of the feedback reports
• perceived personal relevance of feedback

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Applications and Future Directions

• Questionnaire and feedback can structure and
  reinforce advice given by health professionals
• System can offer an efficient way of integrating
  smoking cessation counselling into a busy primary
  care practice
• Internet version
• Pharmacies
• Dental practices
• Workplaces
• Opticians