which types of smokers get which service?
DESCRIPTION
Which types of smokers get which service?. ENQ conference Rome, 10/11 December 2007 Marc Willemsen, Sander Bot, Regina van der Meer. STUDIES (Cost-)effectiveness of quitlines Treatment / service characteristics of callers Quitline tel. on cigaret packs -> call volumes - PowerPoint PPT PresentationTRANSCRIPT
ENQ conference Rome, 10/11 December 2007
Marc Willemsen, Sander Bot, Regina van der Meer
Which types of smokers get which service?
STUDIES
• (Cost-)effectiveness of quitlines
• Treatment / service <–> characteristics of callers
• Quitline tel. on cigaret packs -> call volumes
• HELP campaign -> call volumes
The 9 Participating Quit Lines
• Denmark
• Germany
• Ireland
• Italy
• The Netherlands
• Norway
• Portugal
• United Kingdom• France
STOP-Line Counselling
German Cancer Research Unit
The National Smokers Quitline
Lega Italiana per la lotte contro iI tumo
STIVORO
Directorate for Health and Social Affairs
Instituto Nacional de Cardiologia
Preventiva)
QUIT UK
Insititut National de Prévention et
d’Education pour la Santé
ESCHER Objectives
• Develop an evidence base for European quitlines
• Collect basic data that are usefull for all countries involved and are of interest to the EU
• Strengthen the position of the quitlines
• Take advantage of natural variation between countries (compare quitlines in natural settings)
Which smokers get the most effective treatment from quitlines?
Type of treatment
Literature sent Booklets or leaflets on quitting
Basic information Objective / neutral information about facts, consequences of stopping smoking, craving etc. (quick call)
Specific informationObjective / neutral information about cessation methods (pharmacotherapy), referral to outside services or referral to health professional
AdviceRecommendations on how to quit smoking, eg., what would be the best method to quit or recommendation to see health professional
CounsellingCaller-centred and person-tailored, in-depth, motivational interaction
Hypotheses
1. Heavy smokers more likely to receive counselling + get
specific info on pharmacotherapy
2. Lower educated callers more likely to receive counselling, less
likely to receive brief advice or written materials
3. Callers in action stage more likely to get counselling or
advice, less likely to be referred to outside help
4. Referred callers more likely to get counselling
Method
In each country, during a period of 12 months (February 2005 – April
2006) up to 500 smokers were recruited.
Subjects: “every caller who calls for telephone support for smoking
cessation”.
Data collected by the counsellors during the first contact (intake).
Logistic regression, controlling for country. Method = enter 7 services.
Check country x treatment interactions.
Country Number of respondents
Denmark 425
France 619
Germany 180
Ireland 494
Italy 520
Netherlands 493
Norway 534
Portugal 123
United Kingdom 500
Total 3.888
76,2
14,2
16,9
45
51,3
64
46
Counselling
Referred to healthprofessional
Referred to outsideservice
Info about Pharmaco
Advice on how toquit
Basic info (quick call)
Written materials
%
Services provided to callers
DM FR GE IR IT NE NO PT UK ALL
% low educated 26.1 35.9 25.4 22.1 33.2 27.9 20.8 36.1 38.5 29.3
% heavy smoker
55.5 46.4 48.9 48.5 46.3 58.0 39.3 47.2 46.3 48.3
% action stage
32.0 33.0 23.3 38.5 11.3 31.4 41.4 32.5 35.8 31.8
Copied tel. nr. from cig. pack
27.8 30.7 - - - 12.0 18.7 - - 22.5
Referral by health prof.
14.1 13.6 - 6.1 3.8 14.0 11.6 4.9 12.0 10.1
Heavy smokers (HSI >=3)
No association with counselling (contrary to hypothesis) (75% vs. 78%; ns)
More likely to get information about pharmacotherapy (OR=1.27; 95%CI=1.10-1.47) (hypothesis confirmed)
More often referred to a health professional (OR=1.32; 95CI=1.08-1.60).
Consistent across 9 quitlines
0
10
20
30
40
50
informationpharmacotherapy
referral to healthprofessional
heavy smoker lighter smoker
Low education callers
Not more likely to receive counselling (hypothesis rejected)
No relationship with receiving brief advice or written materials.
(hypothesis rejected).
Low educated
More information on pharmacotherapy(OR=1.18; 95%CI =1.01-1.38)
Consistent across 9 quitlines
0
10
20
30
40
50
low educated higher educated
Low educated: shorter calls
Percentage having a ‘long call’
(>20 minutes)
22,8
31
0
5
10
15
20
25
30
35
Low educated Higher educated
Action stage
More likely:
Advice1
Counselling 2
(Hypothesis confirmed)
1 French, German, Irish quitlines;
2 Italian, Dutch quitlines
83
6669
53
0102030405060708090
advice counselling
action preparation
Action stage
Less likely:
Referral to outside help3
(hypothesis confirmed)
Referral to health
professional4
3 Danish, German, Italian, Portuguese,
English quitlines;
4 Irish, Portuguese
812
41
31
05
1015202530354045
outside help health professional
action preparation
How were callers referred to the quitline?
self-referral; 69,9
family, friends; 9,5
other; 10,5
health professional;
10,1
Callers referred by a health professionalcompared to other referrals
Heavy smokers (53% vs 43%)
Low educated (35% vs 29%)
Callers referred by a health professional
More likely get counselling (hypothesis confirmed) (81% vs 74%)
More likely information on pharmacotherapy (50% vs 38%)
Less likely brief advice (48% vs 54%) and literature (41% vs 49%)
All quitlines, except Danish, French, English (in these countries: more likely to
be further referred to medical professional: 38% vs 10%).
Conclusions
The most effective quitline service (counselling) was provided
to higher educated smokers, callers in action stage of change,
and callers who were referred by a health professional.
Callers who were referred by a health professional more likely
to be low educated and heavy smoker
Although many low educated callers received information
about pharmacotherapy, low educated smokers came of badly
in terms of counselling (less likely + shorter calls).
Conclusions
In contrast to the US and Australia, in these nine European quitlines, only 10% of contacts were referrals from health care providers.
European quitlines should be better integrated into the health care system.
Thanks for your attention!
Contact: [email protected]