Transcript Referrals - Asthma Foundation New Zealand

New Zealand Respiratory Conference
19-20 September 2013
Collaborating with Quitline
to Increase Quitting
Bruce Bassett
20 September 2013
Overview
• Smoking is a leading cause of preventable death and
illness
• Smoking and Asthma
• The benefits of quitting
• The New Zealand approach - Smokefree Aotearoa
2025 goal
• How we can work together to get there
We are still Smoking too Much
650,000 adult smokers
Prevalence
• 18% for total population
• 41% for Maori
• 26% for Pacific Peoples
• 10% for Asian
• 17% for European/Other
Implications
Smoking is
All Bad
• 5,000 New Zealanders die each year from smoking
• Smoking is major reason for life expectancy
disparity between Maori and the general population
Half of the people who smoke today and continue
smoking will eventually be killed by tobacco.
Half of them will die in middle age
World Health Organization. Why is tobacco a public
health priority? Tobacco Free Initiative.
http://www.who.int/tobacco/health_priority
Smoking and Asthma
• Prevalence rates for smoking in asthmatics are
close to those found in the general population1
• Current smokers are 1.33 times and ex-smokers
1.49 times at greater risk of developing asthma
compared to those who have never smoked 2
1.
Polosa, R., Thomson, N.C. (2012). Smoking and asthma:
dangerous liaisons. European Respiratory Journal 41 (3) 716726
2.
Stapleton, M., Howard-Thompson, A., George, C. et al. (2011)
Smoking and Asthma. Journal of the American Board of Family
Medicine, 24 (3) 313-322
Smoking and Asthma
• Asthmatics who smoke are over two and half
times more likely to experience poor long term
control of asthma symptoms compared to nonsmokers1
• Asthmatics who smoke are almost three times
more likely to experience worse asthma
symptoms than nonsmokers2
1.
Schatz, M., Zeiger, R.S., Vollmer, W.M., et al. (2006)
Determinants of future long-term asthma control. Journal of
Allergy and Clinical Immunology. 118, 1226-33
2.Chaudhuri, R., McSharry, C., McCoard, A. et al. (2008). Roled of
symptoms and lung function in determining asthma control in
smokers with asthma. Allergy, 63, 132-5
Asthma in Children Exposed to
Smoking
Maternal smoking is associated with children being:
• Twice as likely to have asthma
• Almost five times more likely to use asthma
medications
• Two and half times more likely to develop asthma
in the first year of life
(compared to those with non-smoking mothers)
Weitzman, M., Gortmaker, S., Klein Walker, D., Sobol,
A. (1990). Maternal Smoking and Childhood Asthma.
Pediatrics 85 (4) 505-511
Second-hand Smoke and
Asthma
Smoke-free legislation in England resulted in an
immediate 8.9% reduction in hospitalizations
for childhood asthma
Millett, C., Tayu Lee, J., Laverty, A.A., Glantz, S.A. and
Majeed, A. (2013). Hospital Admissions for Childhood
Asthma After Smoke-Free Legislation in England.
Pediatrics 131 (2) 495-501
Benefits of Quitting
The British Doctors Study
Doll R, Peto R, Boreham J, Sutherland I.
British Medical Journal, 22 June 2004
• Mortality and cause of death from medical register
and death certificates
• Questionnaires on smoking status 1951,
1957,1966, 1971, 1978, 1991, 2001.
If you Quit, you Recover
By quitting, people regain life expectancy and the
earlier you quit, the greater the gain
Stopping at age 30
10 years
Stopping at age 40
9 years
Stopping at age 50
6 years
Stopping at age 60
3 years
After being quit for 15 years, life expectancy is similar
to a person who has never smoked
Doll R, Peto R, Boreham J, Sutherland I. (2004). "Mortality in
relation to smoking: 50 years' observation on male British
doctors". BMJ 328 (7455): 1519.
So how are we getting on in
New Zealand?
Smoking Rates are Falling
New Zealand Smoking Prevalence – 1983 to 2012
35
30
20
15
10
5
Year
Source: New Zealand Tobacco Use Survey and New Zealand Health Survey
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
0
1983
Percent
25
How has this Been Achieved?
• Government has a long-standing policy framework
to address smoking, including:
- Advertising restrictions
- Smokefree environments
- Point of sale restrictions
- Cessation support
- Tax increases
- Health targets
Next Steps
In 2012, Government established the goal of
Smokefree Aotearoa by 2025
2025 Smoking Rate Trajectory
Quitline
• Supports almost 50,000 clients each year
• 8% of the smoker population
• Delivers to Ministry of Health’s “Smoking Cessation
Services Tier One Level One Service Specification”
• Three-month quit programme
• Minimum of four follow-up contacts and quit status
gathered at 4 weeks and three months
• 24/7 service with phone, online and text channels
• Very active Blog community for peer support with
105,000 blogs and comments over the past year
The Quitline Service
• Evidence-based behavioural approach where clients
receive tailored advice depending on their needs
through a quitting journey
• Provision of NRT is part of the Quitline service
• Electronic and phone services are aligned so that
clients get consistent support regardless of the
service channels (or combination of channels) used
• Clients are encouraged to use all services on offer
How Clients Use Quitline
• Client’s use the phone, text and online services
interchangeably
 65.8% use the phone service
 67.4% use the online services
 33.1% use the text service
Two-thirds of clients use multiple services
Quitline Efficacy
• Overall six month quit rate of 24.2%
(7 day point –
prevalence, intention to treat)
• The more services used the better the quit rate
 Phone only
20.9%
 Online only
26.6%
 Phone and Online
33.4%
 Phone, Online and Text
37.0%
More service use is associated with better
cessation outcomes
Quitline stands as a highly credible
high volume cessation provider,
with excellent quit rates
And, we want more people using the service…
Health Targets - ABC
5,695
referrals to
Quitline
Nearly 1 Million
ABC Conversations
by PHOs and DHBs
each year
Strategies for Health
Professionals
1. Evaluations show that more service use results in
better quit outcomes
2. Research shows that General Practices that refer
smokers to an evidence-based quitline service results
in increased cessation (Borland, 2008)
Borland R, Balmford J, Bishop N, Segan C, Piterman L,
McKay-Brown L, Kirby C, Tasker C. In-practice management
versus quitline referral for enhancing smoking cessation in
general practice: A cluster randomised trial. Family
Practice 2008; 25(5): 382-389.
Borland Research
• Australian trial with two groups:
 standard in-practice GP management
 referral to a quitline service as well as in-practice
management
• Results (3 month abstinence, Intention to Treat):
 12.3% for referral to quitline
 6.9% for standard in-practice care
• The benefit is largely due to patients in the referral
group receiving more external help than patients solely
in the in-practice care
Borland Research
The researchers recommend that:
Quitline referral becomes the normative strategy
for management of smoking cessation in
general practice to complement any practicebased help provided.
We believe this principle will hold true across
the health sector
Building Quitline Referrals
Currently, only 3% of Quitline’s clients are from
referrals, but we believe there is tremendous
opportunity to increase this
We encourage you to refer the people you see who
smoke to Quitline to receive its highly effective care
While a person will quit smoking only if they want to,
we all have a responsibility to make the option of
treatment available to them at every opportunity
How to Refer to Quitline
1. General referral processes – text, fax, email
2. Medtech patient management system referral
process is in place
Quitline is building on these systems and has a project
underway to allow next-step developments
We are aiming for quicker and easier methods,
and with better feedback on client outcomes
How to Think About Cessation
• All people benefit for quitting smoking, and especially
so for people with such conditions as asthma
• Quitting smoking is difficult but getting the best
behavioural support is a great start
• The key findings from evaluations and research is
‘more is better’ - lets build this into all of our
strategies
Collaborating to wrap the best service around our
patients and clients is a contribution we can all
make to Smokefree Aotearoa 2025
– let’s put this into action
Also, we have stand here at the conference, so
do make yourself known to the team
Any Questions?