Effectiveness of telephone intervention for

smoking cessation in patients with mental illness: a pragmatic Randomized Control Trial

Cristina Martínez, Esteve Fernández, Cristina Pinet, Susana Subirá, Montse Ballbè, Laura Alastrue, Roser Blanch,

Joseph Guydish, Eugeni Bruguera, Silvia Mondón, Josep Mª Suelves, Núria Torres, Rosa Hernández*

*Authors do not have conflict of interestFUNDING: PI15/00875 Institut Carlos III

Cristina Martinez Martinez

cmartinez@iconcologia.net

@CrisMarMar

Background

�Around 75% of all patients with mental illnesses smoke (Spain);

�Smoking related diseases account for 48-53% of their deaths;

�Life expectancy in this group is 20-25 years shorter;

�Smokers with mental illnesses neglected of attention/research (20/9000)

�The persistent high smoking rates among this group proposed a challenge:

- for public health

- and for health care services

� According to the few studies available with adequate aid: 10-40% quit

� Where does it work?

- Smoke-free environments

- Multicomponent interventions (motivational + NRT + support)

- Population-based interventions (2 studies on quit lines):

↓ cpd ↑attempts (Morris, 2011; Stockings, 2014).

Background: Interventions

Smoke-free law in Spain regulation in hospitals

2010: extended prohibition to outdoor public areas, including acute hospital grounds

2005: smoking ban in indoor public places

�Several hospitals have integrated tobacco cessation intervention

to mentally ill patients while they are hospitalized;

�The problem comes when these patients are discharged.

Tobacco cessation interventions

�Public telephone assistance service

�Available 24/7

�Addressed to general population

�Under request

�Nurse-led interventions

Catalan Quit line

2a Jornada PPCC

Our solution: QUIT_Mental� Aim: To assess the effectiveness of a multicomponent motivational

intensive telephone-based intervention to quit ("quit line"), addressed

to smoker patients with mental illness after their discharge from

hospitals;

� Design: Experimental Pragmatic Randomized Control Trial (RCT)

Objectives

General:

To assess the effectiveness of a multicomponent motivational intensive

telephone-based intervention to quit ("quit line"), addressed to smoker

patients with mental illness after their discharge from hospitals

Specific:

To evaluate the effectiveness of the intervention in relation to the smokers’

characteristics (mental health disease, age, sex, SES);

Process:

To evaluate the satisfaction of patients who received the “quit line”

Description of the intervention

Intervention Group:

Quit line intervention after discharge; 1st week, 15 days, 1, 3, 6, 9, 12 months,

completely free of charge (+ calls made by the patient)

Components of the intervention

�Intensive motivational intervention call (nurses-led/special training)

�Psico-educative motivational intervention (according to guidelines).

�NRT (Nicotine Replacement Treatment), if necessary.

Control group:

They will receive calls asking whether they smoke (at the same time intervals).

Methods

Participants: Mentally ill smokers that have been admitted into acute

hospitals. Invited before discharge and volunteers. (sample size: 1002)

Hospitals: 5 hospitals (Bellvitge, Clínic, Sant Pau, Fundació Socio Sanitària, Vall

d’Hebron)

Randomization: Through a computer generated (2 IG:1 CG)

Patients will be contacted by the quitline within the first 24 h after discharge.

Variables/Indicators

�Smoking consumption (Yes/No) – self-reported

�Cotinine in saliva (both groups: 6 and 12 months)- Tested in the hospital;

�Smoking pattern (# cpd, smoking dependence (Frageström test)

�Resources used: # of calls, NRT (dose, length), other providers;

�Level of satisfaction with the service/intervention.

• + TSN•n= 668

•HOSPITALIZACIÓN •INTERVENCIÓN AL ALTA

•ALTA

5 Hospitales

Reclutamiento

de 1002

fumadoresNO INTERVENCIÓN

•n=334

•0 1 3 6 9 12Evaluaciones

• • • • ••

•1ª ALTA.

•2ª SEM,

•3ª 15 D

• 4ª • 5º • 6º • 7º • 8º

•SI NO

•¿FUMA?

•* En cada

llamada

•SI NO

•¿FUMA?

•Preguntar sólo si fuma

•Intervención protocolizada

•Muestra de saliva

para cotinina

•Muestra de saliva

para cotinina

Flow chart of the study

Strengths�RCT (IG and CG); Pragmatic (use of an available resource)

�Several evaluations in the follow-up

�Objective measure (level of cotinine)

Main limitations�Complexity of the intervention and the field work

�Possibility of drop-outs

�Costly

�Patients without phone line are excluded

Effectiveness of telephone intervention for

smoking cessation in patients with mental illness: a pragmatic Randomized Control Trial

Cristina Martínez, Esteve Fernández, Cristina Pinet, Susana Subirá, Montse Ballbè, Laura Alastrue, Roser Blanch,

Joseph Guydish, Eugeni Bruguera, Silvia Mondón, Josep Mª Suelves, Núria Torres, Rosa Hernández*

*Authors do not have conflict of interest

Cristina Martinez Martinez

cmartinez@iconcologia.net

@CrisMarMar