Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Tob Control. 2022 Jul;31(4):549-555. doi: 10.1136/tobaccocontrol-2020-056203. Epub 2021 Jan 8.
Tobacco dependence follows a chronic and relapsing course, but most treatment programmes are short. Extended care has been shown to improve outcomes. Examining use patterns for longer term programmes can quantify resource requirements and identify opportunities for improving retention.
We analyse 38 094 primary care treatment episodes from a multisite smoking cessation programme in Ontario, Canada that provides free nicotine replacement therapy (NRT) and counselling. We calculate distributional measures of weeks of NRT used, clinical visits attended and total length of care. We then divide treatment courses into four exclusive categories and fit a multinomial logistic regression model to measure associations with participant characteristics, using multiple imputation to address missing data.
Time in treatment (median=50 days), visits (median=3) and weeks NRT used (median=8) were well below the maximum available. Of all programme enrolments, 28.8% (95% CI=28.3% to 29.3%) were single contacts, 31.3% (30.8% to 31.8%) lasted <12 weeks, 19.2% (18.8% to 19.6%) were ≥12 weeks with an 8-week interruption and 20.7% (20.3%-21.1%) were ≥12 weeks without interruptions. Care use was most strongly associated with participant age and whether the nicotine patch was dispensed at the first visit.
Treatment use results imply that the marginal costs of extending treatment programmes are relatively low. The prevalence of single contacts supports additional engagement efforts at the initial visit, while interruptions in care highlight the ability of longer term care to address relapse. Results show that use of the nicotine patch is associated with retention in care, and that improving engagement of younger patients should be a priority.
烟草依赖呈慢性和复发性病程，但大多数治疗方案时间都较短。延长治疗时间已被证明可以改善治疗效果。对长期治疗方案的使用模式进行研究可以量化资源需求，并发现提高保留率的机会。
我们分析了加拿大安大略省一个多地点戒烟项目的 38094 例初级保健治疗病例，该项目提供免费尼古丁替代疗法（NRT）和咨询。我们计算了使用 NRT 的周数、就诊次数和总治疗时间的分布指标。然后，我们将治疗疗程分为四个排他性类别，并使用多项逻辑回归模型来测量与参与者特征的关联，使用多重插补来解决缺失数据。
治疗时间（中位数=50 天）、就诊次数（中位数=3 次）和 NRT 使用周数（中位数=8 周）远低于可用的最大值。在所有的项目入组中，28.8%（95%CI=28.3%至 29.3%）为单次接触，31.3%（30.8%至 31.8%）持续时间<12 周，19.2%（18.8%至 19.6%）为≥12 周且有 8 周中断，20.7%（20.3%至 21.1%）为≥12 周且无中断。治疗的使用与参与者的年龄以及首次就诊时是否发放尼古丁贴片关系最密切。
治疗使用结果表明，延长治疗方案的边际成本相对较低。单次接触的高患病率支持在初次就诊时进行额外的参与努力，而治疗中断突出了长期治疗解决复发的能力。结果表明，尼古丁贴片的使用与治疗保留率相关，应优先考虑提高年轻患者的参与度。
