Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster‐randomized controlled trial
Autor: | Peter J. Kelly, Robert Stirling, Anthony Shakeshaft, Billie Bonevski, Carrie Fowlie, Catherine D'Este, Christopher Oldmeadow, Michael Farrell, Eliza Skelton, Ashleigh Guillaumier, Adrian Dunlop, Christine Paul, Scott Walsberger, Flora Tzelepis, Kerrin Palazzi |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male medicine.medical_specialty Randomization medicine.medical_treatment media_common.quotation_subject 030508 substance abuse Medicine (miscellaneous) Rate ratio law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Cluster Analysis Humans Patient Reported Outcome Measures 030212 general & internal medicine media_common business.industry Australia Odds ratio Middle Aged Abstinence Nicotine replacement therapy Organizational Innovation Confidence interval Psychiatry and Mental health Smoking cessation Female Smoking Cessation Substance Abuse Treatment Centers 0305 other medical science business Program Evaluation |
Zdroj: | Addiction. 115:1345-1355 |
ISSN: | 1360-0443 0965-2140 |
Popis: | AIM Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up. DESIGN Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016. SETTING Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. PARTICIPANTS Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). INTERVENTION Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. MEASUREMENTS Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. FINDINGS At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. CONCLUSIONS Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking. |
Databáze: | OpenAIRE |
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