New Zealand Respiratory Conference September 2013 Collaborating with Quitline to Increase Quitting Bruce Bassett 20 September 2013

Overview Smoking is a leading cause of preventable death and illness Smoking and Asthma The benefits of quitting The New Zealand approach - Smokefree Aotearoa 2025 goal How we can work together to get there

We are still Smoking too Much 650,000 adult smokers Prevalence 18% for total population 41% for Maori 26% for Pacific Peoples 10% for Asian 17% for European/Other

Implications Smoking is All Bad 5,000 New Zealanders die each year from smoking Smoking is major reason for life expectancy disparity between Maori and the general population Half of the people who smoke today and continue smoking will eventually be killed by tobacco. Half of them will die in middle age World Health Organization. Why is tobacco a public health priority? Tobacco Free Initiative.

Smoking and Asthma Prevalence rates for smoking in asthmatics are close to those found in the general population 1 Current smokers are 1.33 times and ex-smokers 1.49 times at greater risk of developing asthma compared to those who have never smoked 2 1.Polosa, R., Thomson, N.C. (2012). Smoking and asthma: dangerous liaisons. European Respiratory Journal 41 (3) Stapleton, M., Howard-Thompson, A., George, C. et al. (2011) Smoking and Asthma. Journal of the American Board of Family Medicine, 24 (3)

Smoking and Asthma Asthmatics who smoke are over two and half times more likely to experience poor long term control of asthma symptoms compared to non- smokers 1 Asthmatics who smoke are almost three times more likely to experience worse asthma symptoms than nonsmokers 2 1.Schatz, M., Zeiger, R.S., Vollmer, W.M., et al. (2006) Determinants of future long-term asthma control. Journal of Allergy and Clinical Immunology. 118, Chaudhuri, R., McSharry, C., McCoard, A. et al. (2008). Roled of symptoms and lung function in determining asthma control in smokers with asthma. Allergy, 63, 132-5

Asthma in Children Exposed to Smoking Maternal smoking is associated with children being: Twice as likely to have asthma Almost five times more likely to use asthma medications Two and half times more likely to develop asthma in the first year of life (compared to those with non-smoking mothers) Weitzman, M., Gortmaker, S., Klein Walker, D., Sobol, A. (1990). Maternal Smoking and Childhood Asthma. Pediatrics 85 (4)

Second-hand Smoke and Asthma Smoke-free legislation in England resulted in an immediate 8.9% reduction in hospitalizations for childhood asthma Millett, C., Tayu Lee, J., Laverty, A.A., Glantz, S.A. and Majeed, A. (2013). Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England. Pediatrics 131 (2)

Benefits of Quitting The British Doctors Study Doll R, Peto R, Boreham J, Sutherland I. British Medical Journal, 22 June 2004 Mortality and cause of death from medical register and death certificates Questionnaires on smoking status 1951, 1957,1966, 1971, 1978, 1991, 2001.

If you Quit, you Recover By quitting, people regain life expectancy and the earlier you quit, the greater the gain Stopping at age 3010 years Stopping at age 409 years Stopping at age 506 years Stopping at age 603 years After being quit for 15 years, life expectancy is similar to a person who has never smoked Doll R, Peto R, Boreham J, Sutherland I. (2004). "Mortality in relation to smoking: 50 years' observation on male British doctors". BMJ 328 (7455): 1519."Mortality in relation to smoking: 50 years' observation on male British doctors"

So how are we getting on in New Zealand?

Smoking Rates are Falling New Zealand Smoking Prevalence – 1983 to 2012 Source: New Zealand Tobacco Use Survey and New Zealand Health Survey

How has this Been Achieved? Government has a long-standing policy framework to address smoking, including: - Advertising restrictions - Smokefree environments -Point of sale restrictions -Cessation support -Tax increases -Health targets

Next Steps In 2012, Government established the goal of Smokefree Aotearoa by 2025

2025 Smoking Rate Trajectory

Quitline Supports almost 50,000 clients each year 8% of the smoker population Delivers to Ministry of Health’s “Smoking Cessation Services Tier One Level One Service Specification” Three-month quit programme Minimum of four follow-up contacts and quit status gathered at 4 weeks and three months 24/7 service with phone, online and text channels Very active Blog community for peer support with 105,000 blogs and comments over the past year

The Quitline Service Evidence-based behavioural approach where clients receive tailored advice depending on their needs through a quitting journey Provision of NRT is part of the Quitline service Electronic and phone services are aligned so that clients get consistent support regardless of the service channels (or combination of channels) used Clients are encouraged to use all services on offer

How Clients Use Quitline Client’s use the phone, text and online services interchangeably  65.8% use the phone service  67.4% use the online services  33.1% use the text service Two-thirds of clients use multiple services

Quitline Efficacy Overall six month quit rate of 24.2% (7 day point – prevalence, intention to treat) The more services used the better the quit rate  Phone only 20.9%  Online only26.6%  Phone and Online33.4%  Phone, Online and Text 37.0% More service use is associated with better cessation outcomes

Quitline stands as a highly credible high volume cessation provider, with excellent quit rates And, we want more people using the service…

Health Targets - ABC Nearly 1 Million ABC Conversations by PHOs and DHBs each year 5,695 referrals to Quitline

Strategies for Health Professionals 1.Evaluations show that more service use results in better quit outcomes 2.Research shows that General Practices that refer smokers to an evidence-based quitline service results in increased cessation (Borland, 2008) Borland R, Balmford J, Bishop N, Segan C, Piterman L, McKay-Brown L, Kirby C, Tasker C. In-practice management versus quitline referral for enhancing smoking cessation in general practice: A cluster randomised trial. Family Practice 2008; 25(5):

Borland Research Australian trial with two groups:  standard in-practice GP management  referral to a quitline service as well as in-practice management Results (3 month abstinence, Intention to Treat):  12.3% for referral to quitline  6.9% for standard in-practice care The benefit is largely due to patients in the referral group receiving more external help than patients solely in the in-practice care

Borland Research The researchers recommend that: Quitline referral becomes the normative strategy for management of smoking cessation in general practice to complement any practice- based help provided. We believe this principle will hold true across the health sector

Building Quitline Referrals Currently, only 3% of Quitline’s clients are from referrals, but we believe there is tremendous opportunity to increase this We encourage you to refer the people you see who smoke to Quitline to receive its highly effective care While a person will quit smoking only if they want to, we all have a responsibility to make the option of treatment available to them at every opportunity

How to Refer to Quitline 1.General referral processes – text, fax, 2.Medtech patient management system referral process is in place Quitline is building on these systems and has a project underway to allow next-step developments We are aiming for quicker and easier methods, and with better feedback on client outcomes

How to Think About Cessation All people benefit for quitting smoking, and especially so for people with such conditions as asthma Quitting smoking is difficult but getting the best behavioural support is a great start The key findings from evaluations and research is ‘more is better’ - lets build this into all of our strategies Collaborating to wrap the best service around our patients and clients is a contribution we can all make to Smokefree Aotearoa 2025 – let’s put this into action

Any Questions? Also, we have stand here at the conference, so do make yourself known to the team