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Who are smoking cessation services in Scotland reaching? A secondary

analysis of routine data

Jan Kerssens, Cheryl Denny, Linsey Galbraith (ISD)Sally Haw, Linda Bauld (Stirling University )

Rosemary Hiscock (University of Bath)

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Outline• Scotland• Smoking Cessation services• Data set• Interventions• Client groups• Standardised Rates• Funnel plots• Conclusion• Questions

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Scotland• Northern part of UK

mainland• Just over 5 million

inhabitants, concentrated in the central belt

• Edinburgh capital – Glasgow biggest city – 32 Local authorities (councils)

• Islands in the west and the north

• Health inequalities• 24% smokers (top 6 in

Europe)

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Smoking prevalence

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Smoking cessation services

• 14 geographical NHS Health Boards• 32 Local authorities (councils)• 40 Community health partnerships• 4 in Highlands; 3 in Fife; 5 in Glasgow• Rest coterminous with Local authorities• Pharmacy, General practice, Specialist setting• Nicotine Replacement Therapy (NRT),

Varenicline, Group support

The national database

Server at ISD

ISD analysis(no access to person-identifying data)

NHS board staff

NHSNet connection

Data from GG & C

Client information• Age• Sex• Pregnancy• Ethnic

background• Free

prescriptions• Employment

status• Postcode

Tobacco use and Interventions

• Quit date• Pharmaceutical

usage• Behavioural

support• Intervention

setting• Free prescriptions• Follow-up

Outcomes• Success/failure• 3-month follow-

up• 12-month follow-

up

Pharmacy

0

10

20

30

40

50

60

one month cessation three month cessation

Perc

enta

ge (%

)

Pharmacy services All Scotland

• Over 130,000 quit attempts made in 2010-2011

• Broadly, the more deprived the area a client is from, the more chance the client will using a pharmacy service

• Most popular in 18-34 yr age group and least popular with those aged 60+

• Unemployed most likely to use pharmacy service while sick or disabled least likely to

• Variation of Nicotine Replacement Therapy use across NHS boards from 60% to over 90%

NRT

Varenicline

• Variation of Varenicline use across NHS boards from less than 10% to 34% of all quit attempts made

LegendQuit attempt using Varenicline (%)

Other features of different

pharmacotherapy users• Those in paid employment, full-time parents and permanently

sick/disabled use Varenicline more than any other employment groups

• Students and the unemployed use Varenicline the least• Proportionally, more 45-59 year olds used Varenicline than any

other age group (and used NRT the least) while the lowest use of Varenicline was in the younger age groups (e.g. 18-24).

• No difference in prescribing by sex (approx. 75% NRT and 10-11% Varenicline)

• By deprivation: broadly similar percentages of each deprivation group being prescribed Varenicline (around 19%). Lowest in least deprived (14%)

Group Support• Around 30,000 quit attempts

made in 2010-2011 with group support

• The more deprived the area a client is from, the less chance the client will use group intervention. 30% - 5%

• Most popular in <18s and 45-59 age groups (23%) and lowest in those aged 18-34 (14-17%).

• Highest uptake in homemakers, the employed and sick/disabled (22-25%). Lowest in unemployed (11%).

0

10

20

30

40

50

60

one month cessation three month cessation

Perc

enta

ge (%

)

Group Intervention All Scotland

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2- years reach

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Client sub-groups

Pharmacy Multiple product

NRT

Varenicline Groupsupport

Total 70% SR 28% SR 10% SR 15% SR

Male 70% 1.00 27% 0.99 10% 1.00 15% 0.99

Female 70% 1.00 28% 1.01 10% 1.00 15% 1.00

Young (15-24) 77% 1.10 27% 0.98 5% 0.50 10% 0.67

Not young 70% 0.99 28% 1.00 11% 1.06 15% 1.04

Most deprived 76% 1.08 27% 0.97 8% 0.79 13% 0.89

Rest of Scotland 67% 0.95 28% 1.02 11% 1.12 16% 1.06

Pregnant 40% 0.62 11% 0.64

Not pregnant 67% 1.03 17% 1.03

Percentage and Standardised Rates

N=192,194

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Standardised Rates (SR)

• Indirect standardised rates for each service• For example, when 88% of men undertook a

quit attempt in pharmacy (numerator)• And 80% of all the quit attempt in were in

pharmacy (denimonator)• The SR is then 88/80 = 1.10 for men in

pharmacy in that service• Over-representation of 10%• Rates suppressed when numerator < 5 and/or

denomiator < 30• Difference with Scotland’s SR (+/- 3 SD)

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A funnel plot is a graph with a performance indicator on the vertical-axis

and the number of observations on the horizontal-axis

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A data point is added for each service…

Scotland’s SR is added as a horizontal line...

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Control limits are added, assuming that the services differ by chance

only…

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Young age and group support

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Results/Conclusion• The reach for some services showed gaps for

young people in – Providing multiple product NRT (13 out of 40)– Providing varenicline (13 out of 37)– Group support (19 out of 34)

• The reach for some services showed gaps for people in most deprived areas– Quit attempts in pharmacy (14 out of 40)

• Very few gaps were found for men and women• Pregnancy too many small numbers• Using Standardised Rates for smoking

cessation interventions seems to offer a useful frame work for analysing service reach

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Questions …

Reach and Outcome

• Absolute and relative numbers of successful quit attempts

• Outcome varies from 27% to 55% (Scotland 38%)

• Reach varies from 6% to 29% (Scotland 18%)• Success in terms of

– High success rate / low volume– Low success rate / high volume

• Success per 100 smokers25

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