Empowering smokers with a web-assisted tobacco intervention to use prescription smoking cessation medications: a feasibility trial

Implementation Science

Laurie Zawertailo³  Sabrina Voci²  Sarwar Hussain²  Peter Selby¹ 

[1] Ontario Tobacco Research Unit, 155 College Street, Toronto M5T 3M7, ON, Canada;Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto M6J 1H4, ON, Canada;Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Circle, Toronto M5S 1A8, ON, Canada

关键词: Feasibility study;    Pilot study;    Web-assisted tobacco intervention;    Open-label;    Varenicline;    Bupropion;    Smoking cessation;    Smoking;    Tobacco;   

Others  :  1229123
DOI  :  10.1186/s13012-015-0329-7

 received in 2015-07-07, accepted in 2015-09-21,  发布年份 2015

【 摘 要 】

Background

Varenicline and bupropion, efficacious smoking cessation medications, have had suboptimal impact due to barriers at the patient, practitioner and system level. This study explored the feasibility of a web-assisted tobacco intervention offering free prescription smoking cessation medication by mail if the smoker visited a physician for authorization.

Methods

Adult Ontarians, smoking at least 10 cigarettes daily, intending to quit within 30 days, with no contraindications to bupropion or varenicline were eligible. After an online assessment, eligible participants received an electronic personalized printable prescription form for a 12-week course of varenicline or bupropion to bring to a physician within 3 weeks for authorization, if appropriate. The physician’s office faxed prescriptions to an online pharmacy that couriered medication to the patient following medication counselling by telephone. Weekly motivational emails were sent during treatment. Participants were asked to complete follow-up questionnaires online at 7, 11, 15 and 41 weeks after enrollment.

Results

In total, 1214 individuals submitted an online assessment from April to September 2010 and 73.6 % (95 % confidence interval (CI) = 71.1–76.1 %; n = 893) were eligible. At least 65.8 % (95 % CI = 62.7–68.9 %; n = 588) of eligible participants subsequently visited a physician and 58.7 % (95 % CI = 55.5–61.9 %; n = 524) received medication (50.6 % varenicline [n = 265] and 49.4 % bupropion [n = 259]). Reasons for not filling a prescription were failure to visit a physician (80.1 %; 95 % CI = 73.8–86.5 %; n = 121), physician not prescribing the medication (15.9 %; 95 % CI = 10.1–21.7 %; n = 24) or other reasons (4.0 %; 95 % CI = 0.9–7.1 %; n = 6). Follow-up response rate was 66.7 % (95 % CI = 63.7–69.8 %; n = 596). Minimal issues were encountered with printing the prescription or medication delivery.

Conclusions

This study establishes the feasibility of using the Internet and free medication to enable smokers to engage physicians to treat this addiction. Implementation of this intervention can be scaled up by leveraging existing healthcare systems to treat smokers on a population level. Further evaluation in a randomized controlled trial is necessary.

Trial registration

ClinicalTrials.gov Identifier NCT01023659

【 授权许可】

   
2015 Selby et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. World Health Organization, Geneva, Switzerland; 2013.
• [2]Centers for Disease Control and Prevention. Smoking and tobacco use: fast facts. Atlanta, GA: Centers for Disease Control and Prevention. 2014. http://www.cdc.gov/Tobacco/data_statistics/fact_sheets/fast_facts/index.htm. Accessed May 20 2014.
• [3]Quitting smoking among adults—United States, 2001–2010. Morb Mortal Wkly Rep. 2011; 60(44):1513-9.
• [4]Reid JL, Hammond D, Rynard VL, Burkhalter R. Tobacco use in Canada: patterns and trends, 2014 edition. Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON; 2014.
• [5]Marques-Vidal P, Melich-Cerveira J, Paccaud F, Waeber G, Vollenweider P, Cornuz J. Prevalence and factors associated with difficulty and intention to quit smoking in Switzerland. BMC Public Health. 2011; 11(1):227. BioMed Central Full Text
• [6]Zhu S-H, Lee M, Zhuang Y-L, Gamst A, Wolfson T. Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades? Tob Control. 2012; 21(2):110-8.
• [7]Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004; 99(1):29-38.
• [8]Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database Syst Rev. 2013; 5:CD009329.
• [9]Lemmens V, Oenema A, Knut IK, Brug J. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008; 17(6):535-44.
• [10]Shiffman S, Brockwell SE, Pillitteri JL, Gitchell JG. Use of smoking-cessation treatments in the United States. Am J Prev Med. 2008; 34(2):102-11.
• [11]Vogt F, Hall S, Marteau TM. Understanding why smokers do not want to use nicotine dependence medications to stop smoking: qualitative and quantitative studies. Nicotine Tob Res. 2008; 10(8):1405-13.
• [12]Hammond D, McDonald PW, Fong GT, Borland R. Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behaviour. Addiction. 2004; 99(8):1042-8.
• [13]Reda AA, Kotz D, Evers S, van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev. 2012; 6:CD004305.
• [14]Selby P, Brosky G, Oh P, Raymond V, Arteaga C, Ranger S. A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (ACCESSATION). BMC Public Health. 2014; 14(1):433. BioMed Central Full Text
• [15]Cokkinides VE, Ward E, Jemal A, Thun MJ. Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000. Am J Prev Med. 2005; 28(1):119-22.
• [16]Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ et al.. Treating tobacco use and dependence: 2008 update—clinical practice guideline. 2008. Public Health Service, US Department of Health and Human Services, Rockville, MD; 2008.
• [17]Canadian smoking cessation clinical practice guideline. Centre for Addiction and Mental Health, Toronto, Canada; 2011.
• [18]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L et al.. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001; 39:II2-II45.
• [19]Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. Br Med J. 1998; 317(7156):465-8.
• [20]Carson KV, Verbiest ME, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ et al.. Training health professionals in smoking cessation. Cochrane Database Syst Rev. 2012; 5:CD000214.
• [21]Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995; 274(9):700-5.
• [22]Stacey D, Hill S. Patient-direct and patient-mediated KT interventions. In: Knowledge translation in health care: moving from evidence to practice. Straus S, Tetroe J, Graham ID, editors. John Wiley & Sons, Ltd, Chichester, UK; 2013: p.197-211.
• [23]Williams GC, McGregor HA, Sharp D, Levesque C, Kouides RW, Ryan RM et al.. Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial. Health Psychol. 2006; 25(1):91-101.
• [24]Zawertailo L, Dragonetti R, Bondy SJ, Victor JC, Selby P. Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study. Tob Control. 2013; 22(3):e4.
• [25]Cummings KM, Fix B, Celestino P, Carlin-Menter S, O'Connor R, Hyland A. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs. J Public Health Manag Pract. 2006; 12(1):37-43.
• [26]Feeley N, Cossette S, Côté J, Héon M, Stremler R, Martorella G et al.. The importance of piloting an RCT intervention. Can J Nurs Res. 2009; 41(2):84-99.
• [27]Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP et al.. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010; 10(1):1. BioMed Central Full Text
• [28]Experiences with primary health care in Canada. Canadian Institute for Health Information, Ottawa; 2009.
• [29]Costello MJ, Sproule B, Victor JC, Leatherdale ST, Zawertailo L, Selby P. Effectiveness of pharmacist counseling combined with nicotine replacement therapy: a pragmatic randomized trial with 6987 smokers. Cancer Causes Control. 2011; 22(2):167-80.
• [30]Reid J, Hammond D. Tobacco use in Canada: patterns and trends, 2009 edition (v2). Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON; 2009.
• [31]Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB et al.. Varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006; 296(1):47-55.
• [32]Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE et al.. Efficacy of varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006; 296(1):56-63.
• [33]Siahpush M, Shaikh RA, McCarthy M, Kessler AS, Tibbits M, Singh GK. Association between duration of use of pharmacotherapy and smoking cessation: findings from a national survey. BMJ Open. 2015; 5(1):e006229.
• [34]Canadian Community Health Survey (CCHS), 2009–2010. Statistics Canada, Ottawa; 2011.
• [35]Collins LM, Schafer JL, Kam C-M. A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychol Methods. 2001; 6(4):330-51.
• [36]Stata Statistical Software: Release 12. StataCorp LP, College Station; 2011.
• [37]SPSS for Windows, Version 16.0. SPSS Inc., Chicago, IL; 2007.
• [38]Access to a regular medical doctor, 2013. Statistics Canada, Ottawa; 2014. http://www. statcan.gc.ca/pub/82-625-x/2014001/article/14013-eng.htm. Accessed June 25 2015
• [39]Birnbaum MH. Human research and data collection via the Internet. Annu Rev Psychol. 2004; 55:803-32.
• [40]Abroms LC, Ahuja M, Kodl Y, Thaweethai L, Sims J, Winickoff JP et al.. Text2Quit: results from a pilot test of a personalized, interactive mobile health smoking cessation program. J Health Commun. 2012; 17(suppl 1):44-53.
• [41]Canadian Internet use survey, 2012. Statistics Canada, Ottawa; 2013. http://www. statcan.gc.ca/daily-quotidien/131126/dq131126d-eng.htm. Accessed January 26, 2015
• [42]Rates of Internet use, by age group, selected years. Statistics Canada, Ottawa; 2009. http://www. statcan.gc.ca/pub/11-008-x/2009002/c-g/10910/c-g001-eng.htm. Accessed January 26, 2015
• [43]Cunningham JA, Leatherdale ST, Selby PL, Tyndale RF, Zawertailo L, Kushnir V. Randomized controlled trial of mailed nicotine replacement therapy to Canadian smokers: study protocol. BMC Public Health. 2011; 11(1):741. BioMed Central Full Text