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A survey of tobacco cessation support in 121 countries Martin Raw University of Nottingham, UK, Federal University of Sao Paulo, Brazil
UKNSCC June 2013
Survey team and papers Martin Raw, Ann McNeill, Rachael Murray, Hemba Pine Abata, Nancy Rigotti, Asaf Bitton
Piné-Abata H, McNeill A, Raw M, Bitton A, Rigotti N, Murray R. A survey of tobacco dependence treatment guidelines in 121 countries. Addiction 2013, online Piné-Abata H, McNeill A, Murray R, Bitton A, Rigotti N, Raw M. A survey of tobacco dependence treatment services in 121 countries. Addiction 2013, online The papers will be free to view for everyone
Survey funding MR
’
s time on this survey was funded by the Society for the Study of Addiction, to whom we are extremely grateful
Interests statement I do not accept funding from the manufacturers of stop smoking medications My funding since 2008 is from: Bloomberg Philanthropies, Society for the Study of Addiction, Roswell Park Transdisciplinary Tobacco Use Research Centre, SRNT, FCA, Global Bridges
Sample
All Parties to the FCTC in December 2011
173 (174 less EU)
Couldn ’t find contacts in 10 so 163
We surveyed four UK countries separately so
166 survey emails sent out
121 replies (73%)
Response rates by region and income level
Basic infrastructure Does your country
Have an officially identified person responsible for treatment?
Have national treatment guidelines?
e Have a clearly identified budget for treatment?
Offer to help healthcare workers to stop using tobacco?
Mandatory recording of tobacco use in medical notes n = 121
% Yes 41 44 20 46 22
Basic infrastructure by income level
Official responsible for treatment National guidelines Clearly identified treatment budget Help for healthcare workers Mandatory recording of tobacco use
High 47 75 36 56 28 UM % Yes LM 44 40 42 30 17 47 25 17 40 13 Low 21 11 0 32 16
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries; Low=Low income countries
Components of national treatment system Does your country
Run mass media campaigns promoting cessation?
Promote/encourage brief advice in existing services?
Have a national telephone quitline?
Have nationwide specialised treatment facilities?
Have specialised treatment facilities but only in selected areas?
Have no specialised treatment facilities at all?
n = 121
% Yes 54 56 36 17 51 32
Components of national treatment system by income level
Promote brief advice National quitline
High 56 75 UM % Yes LM 50 60 28 20 Low 63 5
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries; Low=Low income countries
Quitline characteristics Does the quitline
Offer free callers for calling in?
Have people answering always or almost always?
Offer multiple sessions with counsellors calling back offering ongoing support?
Refer to local specialist treatment services?
Offer information about tobacco cessation medications?
Offer tobacco cessation medication to callers?
n = 44
% Yes 73 80 56 86 80 21
Specialised treatment provision by income level
Has nationwide treatment services Has no treatment services at all n = 121
High 36 14 UM 19 % Yes LM 0 25 43 Low 0 63
High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries; Low=Low income countries
Availability of help by income level
Can tobacco users easily get help to stop in the following settings?
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% General/family practice Pharmacists All High Dentists Hospitals Upper-middle Addiction services Work places Educational institutions Lower-middle Prisons Traditional health practitioners / healers From the internet Low
Availability of medications by income level NRT Bupropion Varenicline Cytisine All
(n=121)
High
(n=36)
51 17 52 10
97 42 83 3
UM
(n=36) 61 14 58 17
% Yes LM Low
(n=30) (n=19) 17 0 33 13
0 0 11 5 Respondent ’s awareness of medication
(n/base) 92 100 86 67 High=High income countries; UM=Upper middle income countries; LM=Lower middle income countries; Low=Low income countries
Affordability of medications by income level NRT Bupropion Varenicline Cytisine
* % expressed as n/base
All
81 70 48
100 High
94 80 64
100 % Yes * UM
60 40 32
100 LM
63 29
100 Low
0
100
Basic infrastructure Does your country
Have an officially identified person responsible for treatment?
Have national treatment guidelines?
e Have a clearly identified budget for treatment?
Offer to help healthcare workers to stop using tobacco?
Mandatory recording of tobacco use in medical notes n = 121
% Yes 41 44
(n = 53)
20 46 22
Countries that have treatment guidelines by region and income level
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Guidelines content
For whole healthcare system and all professionals?
Do they recommend brief advice?
Do they recommend quitlines?
Do they recommend intensive specialist support?
Do they recommend medications?
Do they include evidence on cost effectiveness?
Do they reference the Cochrane Library?
Are they based on another country ’ s guidelines?
Do they stress importance of service providers not using tobacco?
n = 53
% Yes 72 93 66 93 96 45 68 55 57
Guidelines writing process
Did national professional associations participate in drafting and/or reviewing?
Are they formally endorsed by national prof associations?
Are they formally endorsed by your government?
Do they clearly describe the writing and review process?
Were they peer reviewed?
n = 53
% Yes 70 68 70 66 72
Funding and conflicts of interest
Do they clearly state who funded the guidelines?
Did they receive financial support from government or other public health organisations?
Did they receive financial support from the pharmaceutical industry?
Do they include conflict-of-interest statements for all authors?
Do the names and/or logos of any pharmaceutical companies appear in the guidelines?
n = 53
% Yes 76 77 15 40 11
Guidelines dissemination strategy
Is there a strategy to disseminate the guidelines?
n = 53
% Yes 57
Conclusions
Very good response rate – possibly largest most detailed international treatment survey ever
The basic infrastructure data suggest that for most countries treatment is low on their agenda
Perhaps not surprisingly provision of cessation support is related to income level
Key measure for getting tobacco use on healthcare system agenda – recording tobacco use in notes – VERY POOR INDEED
Conclusions
Relatively few countries have quitlines
Their provision also is strongly related to income level
Those that exist are run broadly in line with the evidence base
Provision of specialist treatment facilities strongly related to income level
As is the rated affordability of medications
Can tobacco users easily get help to stop in various settings?
The reality is that in most of the world tobacco users cannot easily get help to stop
Outside high income countries NO percentage reached 30% in any setting
Even in high income countries percentage only exceeded 30% in general practice, pharmacies, hospitals, and from the internet
Guidelines
Broadly evidence based
More than half based on those of other countries
Majority follow good practice in their writing
Except in declaration of conflicts-of-interest
Only half had a dissemination strategy
Guidelines
Clear relationship between having guidelines and income level
Most high income countries have guidelines but very few low income countries
No African countries in our survey have guidelines
What should ALL countries be doing now?
1.
Ensuring that tobacco use is recorded in notes 2.
Addressing the issue of tobacco use in healthcare workers (including helping them stop) 3.
Integrating brief advice into healthcare systems (or at least making a start on this) 4.
Encourage the licensing of affordable medications
One sentence summary of our results?
Offering support to tobacco users who wish to stop is not yet a priority for the majority of countries in the world
Thank you [email protected]
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