Effectiveness of Providing Free Nicotine Replacement Therapy Through Ontario Family Health Teams: Preliminary Findings Dr. Peter Selby MBBS, CCFP, FCFP, June 6, 2012 Justine Mascarenhas MSc, Janine Fitzpatrick MCogSc, Laurie Zawertailo PhD, Sarwar Hussain MSc, Rosa Dragonetti MSc, Peter Selby MBBS STOP Program, Nicotine Dependence Service Centre for Addiction and Mental Health 1
Acknowledgements Ontario Ministry of Health and Long-Term Care STOP and TEACH Project teams Family Health Team practitioners 2
STOP STUDY: www.stopstudy.ca What is the best way to get NRT to smokers 2005 Over 80,000 Ontario smokers Direct: mail, phone, internet, mobile clinics Intermediary: HCPs/settings- PHU. Combined Quit rates: 10 to 15% ITT 7 day ppt Evaluation: REAIM 3
Applying the Knowledge to Action Framework Top 4 barriers to practice change at 3-months: Time Client motivation Funding Need more practice Postcourse online follow-up Attend TEACH Certificate Program and join Community of Practice Regional Practice Leaders TEACH Listserv #teachproject Trainers Toolkits Monthly Interactive Webinars 4
Background: STOP with Family Health Teams (FHTs) Enhance Practitioner Capacity practitioner Comprehensive, evidence-based smoking cessation treatment program Facilitate Knowledge Exchange knowledge broker patient Increase Patient Access to Evidence-Based Treatment designed to address barriers to implementing best practices 5
Treatment: Up to 26 weeks/year of free treatment provided by nursing and/or allied health staff patch lozenge + gum inhaler Counselling intensity and duration decided by practitioners and patients Off-label, titrated-to-effect dosing permitted via medical directive 6
Data Collection Enrollment 3 months 6 months 9 months 12 months Baseline Questionnaire completed by patient Practitioner documents smoking status and NRT dispensing at treatment visits Follow-up by STOP Staff (email/phone) Follow-up by STOP Staff (email/phone) Follow-up by STOP Staff (email/phone) Follow-up by STOP Staff (email/phone) 7
Objectives of Analysis To describe the baseline characteristics of the patients that have enrolled in the STOP with FHTs program To assess interim outcomes regarding the effectiveness of providing free smoking cessation treatment through the STOP with FHTs program 8
Methods Letter from MOHLTC to FHT, capacity assessment CAMH MOU with FHT Ongoing feedback loops, training via webinar. Baseline characteristics of participants were identified Interim quit rates and other smoking cessation outcomes from 3-month follow-up were determined 9
Results: Baseline Participant Demographics 4086 patients at 97 Family Health Teams were enrolled between July 2011 Jan 2012 Average age 51 years old Gender 44% male Annual household income 48% < $40,000 Full-time employment 32% High school diploma and/or post-secondary education 69% Lifetime mental illness diagnosis (self-reported) 46% 10
Results: Baseline Smoking Characteristics Cigarette Consumption Mean: 21 cig/day Mode: 25 cig/day Range: 1-100 cig/day Time To First Cigarette % participants Within 5 minutes 39 6 to 30 minutes 41 31 to 60 minutes 12 More than 60 minutes 7 Heaviness of Smoking Index % participants Low (0-1) 10% Moderate (2-4) 63% High (5-6) 27% 11
Results: Smoking Status at 3m Follow-up 1874/3573 3-month follow-ups completed (as of 15/04/12) Among respondents: 40% abstinent (i.e.: answered no to question: have you smoked a cigarette, even a puff, over the past 7 days?) 72% of those who were still smoking had made at least 1 serious quit attempt in the past 3 months (i.e. had quit for at least 24 hours) Mean cigarette consumption for those still smoking: 11 cigarettes per day (range: 1 78; mode: 2) 12
Results: Tobacco Dependence at Baseline (n=3901) and 3-month Follow-up (n=1072) 60 50 50 40 % of participants 40 30 20 % of participants 30 20 10 10 0 0 to 9 10 to 19 20 to 29 30+ 0 <6min 6-30min 31-60min >60min Cigarettes Per Day Time to First Cigarette N.B. CPD values for 3-m Follow-Up reflect only those still smoking at follow-up. 13
Conclusions Interim results suggest that: Smokers (even those with mental illness) can be engaged in the quit process by primary care providers when free comprehensive treatment is offered Providing free NRT plus counselling can be effective in helping smokers quit in the real world Shifts in cigarette consumption and time to first cigarette suggest that tobacco dependence is reduced in those not yet abstinent Please do not cite: results are preliminary 14
Questions? Peter Selby peter_selby@camh.net 416-535-8501 x 4946 15