1 Tobacco addiction treatment: from evidence to practice University College London November 2012 Susan Michie Robert West

Outline 2 The design-evaluation cycle The case of smoking tobacco addiction treatment The future

The design-evaluation cycle Treatment concept/ innovation Evaluation Implementation Evaluation 3

Tobacco dependence treatment to date Treatment concept/ innovation Evaluation Implementation Evaluation 4 Randomised trials/ quasi-experiments

Tobacco dependence treatment to date Treatment concept/ innovation Evaluation Implementation Evaluation 5 Service monitoring

Tobacco dependence treatment in England Treatment concept/ innovation Evaluation Implementation Evaluation 6 National Centre for Smoking Cessation and Training (NCSCT)

Tobacco dependence treatment to date Treatment concept/ innovation Evaluation Implementation Evaluation 7 Randomised trials/ quasi-experiments

Brief advice: efficacy 8 Stead et al 2008, Cochrane Very brief advice: N=13,724 More extensive advice: N=1,254 95% confidence intervals from meta-analyses Aveyard et al 2012, Addiction Advice only increased quit attempts by 24% (95% CI: 16-33%) Offering behavioural support increased quit attempts by 117% (95% CI: %) Offering prescription increased quit attempts by 68% (95%CI: 48-89%)

Medications: efficacy 9 Stead et al 2008, Cahill et al 2012, Cochrane Varenicline: N=6,166 Single NRT: N=51,265 Dual NRT: 4,664 NRT for ‘reduce to quit’: N=3,429 95% confidence intervals from meta-analyses

Behavioural support: efficacy 10 Stead et al 2012, Cochrane 1 Individual vs brief advice: N=7,855 Group vs self-help: N=4,375 Internet vs nothing: N=2,960 Text messaging versus control messages: N=9,110 Written materials: N=15,117 95% confidence intervals from meta-analyses 1 Updates about to be published Treat with caution Available as evaluated through the NHS

Tobacco dependence treatment to date Treatment concept/ innovation Evaluation Implementation Evaluation 11 Service monitoring

Impact of NHS Stop-Smoking Services: Impact: Number of 4-week quitters generated over and above assumed rate for medication alone (West et al Submitted)

NHS Stop-Smoking Services 2010/11: variation by individual service 13

Tobacco dependence treatment in England Treatment concept/ innovation Evaluation Implementation Evaluation 14 National Centre for Smoking Cessation and Training (NCSCT)

Components behavioural support Medication options Service structure Identify best practice Online knowledge and face-to-face skills training Online assessment Website and resources (e.g. Standard Treatment Plan) Online Very Brief Advice training Translate into training, assessment and resources Evaluate knowledge and skills training Evaluate upgrading of service (e.g. Boots Trial) Evaluate specific innovations (e.g. text messaging) Evaluate innovation 15

Examples of NCSCT research output 16 Identifying optimum medication provision Identifying behaviour change techniques associated with more effective support Explaining difference in success rates between specialist and non-specialist practitioners Does it make a difference which specialist stop-smoking practitioner one sees? Assessing delivery of behavioural support in practice Evaluating the effectiveness of NCSCT knowledge and skills training

Examples of NCSCT products and services 17 Online practitioner training and assessment Skills training course Standard Treatment Plan Gold Standard Monitoring Form Very Brief Advice training and assessment Service audit and accreditation system

Where now? standard monitoring form and database specification of treatment provision data sharing International collaboration and data monitoring Upgrading and evaluating service provision Introduction of new technology Innovation and evaluation 18 The Sydney Model? Adding technological innovation?

Treatment concept/ innovation Evaluation Implementation Evaluation It’s up to us 19