1 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)

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

3 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)

4 Smoking prevalence

5 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 Over 130,000 quit attempts made in Broadly, the more deprived the area a client is from, the more chance the client will using a pharmacy service Most popular in 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 Legend Quit 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 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 ). 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 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 age groups (23%) and lowest in those aged (14-17%). Highest uptake in homemakers, the employed and sick/disabled (22- 25%). Lowest in unemployed (11%).

15 2- years reach

16 Client sub-groupsPharmacyMultiple product NRT VareniclineGroup support Total70% SR28% SR10% SR15% SR Male70% % % % 0.99 Female70% % % % 1.00 Young (15-24)77% % % % 0.67 Not young70% % % % 1.04 Most deprived76% % % % 0.89 Rest of Scotland67% % % % 1.06 Pregnant40% % 0.64 Not pregnant67% % 1.03 Percentage and Standardised Rates N=192,194

17 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)

18 A funnel plot is a graph with a performance indicator on the vertical-axis and the number of observations on the horizontal-axis

19 A data point is added for each service…

Scotland’s SR is added as a horizontal line... 20

Control limits are added, assuming that the services differ by chance only… 21

Young age and group support 22

23 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

24 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 smokers 25

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