Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2020 Jul 10;15(7):e0235709. doi: 10.1371/journal.pone.0235709. eCollection 2020.
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.
自 2005 年以来，安大略省戒烟治疗（STOP）计划通过 11 种不同的治疗模式，为吸烟者提供不同形式和强度的戒烟治疗，这些模式可以在合作医疗组织的现场进行，也可以通过网络或电话远程进行。我们旨在描述不同治疗模式所覆盖的患者群体。
我们将自我报告数据与健康管理数据库相链接，以描述社会人口统计学、身体和心理健康合并症、医疗保健利用和成本。我们的样本包括 2005 年 10 月 18 日至 2016 年 3 月 31 日期间参加 11 种不同时期运行的治疗模式的 107302 名患者。
患者群体在社会人口统计学、合并症负担和医疗保健使用方面存在差异。基于网络的模式的参与者年龄最小（中位数年龄：39；IQR：29-49），而基于初级保健的家庭健康团队的参与者年龄最大（中位数：51；IQR：40-60）。慢性阻塞性肺疾病和高血压是最常见的身体合并症，在家庭健康团队中出现的频率是直接向吸烟者（网络和电话）和药店模式的两倍（分别为 32.3%和 30.8%）。在家庭健康团队中，抑郁是最常见的心理健康诊断，在成瘾机构中出现的频率是电话模式的两倍（52.1%比 25.3%）。在注册前的两年中，医疗保健费用中位数从电话模式的 1787 美元到成瘾机构模式的 9393 美元不等。
虽然从业者介导的专门和初级保健模式为更复杂的医疗需求的吸烟者提供了服务，但替代模式似乎更适合在这些合并症发生之前，接触到更年轻的吸烟者。虽然网络和电话模式预计会有更少的获取障碍，但它们在农村地区和社会经济地位较低的患者中覆盖率较低。研究结果表明，除了基于人群的策略外，将戒烟治疗纳入能够接触到不同差异的患者群体的现有医疗保健环境中，可能会增强公平获得治疗的机会。
