Abstract
Since 2005, the Smoking Treatment for Ontario Patients (STOP) program has provided smoking cessation treatment of varying form and intensity to smokers through 11 distinct treatment models, either in-person at partnering healthcare organizations or remotely via web or telephone. We aimed to characterize the patient populations reached by different treatment models. We linked self-report data to health administrative databases to describe sociodemographics, physical and mental health comorbidity, healthcare utilization and costs. Our sample consisted of 107,302 patients who enrolled between 18Oct2005 and 31Mar2016, across 11 models operational during different time periods. Patient populations varied on sociodemographics, comorbidity burden, and healthcare usage. Enrollees in the Web-based model were youngest (median age: 39; IQR: 29-49), and enrollees in primary care-based Family Health Teams were oldest (median: 51; IQR: 40-60). Chronic Obstructive Pulmonary Disease and hypertension were the most common physical health comorbidities, twice as prevalent in Family Health Teams (32.3% and 30.8%) than in the direct-to-smoker (Web and Telephone) and Pharmacy models (13.5%-16.7% and 14.7%-17.7%). Depression, the most prevalent mental health diagnosis, was twice as prevalent in the Addiction Agency (52.1%) versus the Telephone model (25.3%). Median healthcare costs in the two years up to enrollment ranged from $1,787 in the Telephone model to $9,393 in the Addiction Agency model. While practitioner-mediated models in specialized and primary care settings reached smokers with more complex healthcare needs, alternative settings appear better suited to reach younger smokers before such comorbidities develop. Although Web and Telephone models were expected to have fewer barriers to access, they reached a lower proportion of patients in rural areas and of lower socioeconomic status. Findings suggest that in addition to population-based strategies, embedding smoking cessation treatment into existing healthcare settings that reach patient populations with varying disparities may enhance equitable access to treatment.
Highlights
More than 1 billion people smoke tobacco [1]
Population-based strategies have been used to distribute a standard supply of nicotine replacement therapy (NRT) with brief counselling, which has included: mail-out of NRT to individuals who enrolled via telephone or website; providing eligible smokers with vouchers for NRT to be redeemed at a local partnering pharmacy; and distributing NRT kits at smoking cessation workshops held at Battle River Treaty 6 Healthcare, Lung Association of Nova Scotia, Exchange Summit, Toronto Public Health, Ontario Association of Public Health Dentistry and ECHO
Onethird (30.4%) of patients were enrolled in the Family Health Team model, another quarter (27.6%) were enrolled in the Telephone model, 17.3% were enrolled in Workshops, and the rest were distributed across other models
Summary
More than 1 billion people smoke tobacco [1]. The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has endorsed six tobacco control policies to address the global tobacco epidemic: monitor tobacco use and prevention policies; protect people from tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; raise taxes on tobacco; and offer help to quit tobacco use [1]. Offering NRT for free or at a reduced cost has been shown to increase the proportion of smokers who make a quit attempt, use smoking cessation treatment, and successfully quit smoking [8,9,10,11,12] The STOP program has delivered smoking cessation treatment in 11 distinct models, which intentionally vary in recruitment methods, point of contact, mode of delivery, personnel of delivery, intensity of contact and combinations of behavioural support and pharmacotherapies (see Table 1) Models include those engaging people who smoke both directly and through partnering healthcare organizations [13,14,15,16,17], via either self-referral or referral from a healthcare practitioner. We aimed to characterize the patient populations reached by different treatment models
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