Lisa McKay-Brown

In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial

BACKGROUND AND OBJECTIVE GPs are an important source of smoking cessation advice. This research examined whether a model encouraging GP referral of patients who smoke to a specialist service would be acceptable and effective for increased smoking cessation when compared with a model of in-practice management. METHODS The study design was cluster randomized controlled trial. Practices were randomized to one of two interventions, at a rate of 1:2: (i) standard in-practice GP management or (ii) referral to a quitline service. The main outcome measures were sustained abstinence of >or=1 month duration at 3-month follow-up and >or=10 months duration at 12 months, using intention to treat analysis. RESULTS At 3-month follow-up, patients in the referral condition were twice as likely to report sustained abstinence than those in the in-practice condition [12.3% compared with 6.9%; odds ratio (OR) = 1.92 (95% confidence interval (CI) 1.17-3.13]. At 12-month follow-up, patients in the referral condition had nearly three times the odds of sustained abstinence [6.5% compared with 2.6%; OR = 2.86 (95% CI 0.94-8.71)]. The intervention effect was mediated by the amount of help received outside the practice. CONCLUSIONS This research provided evidence that GPs referring smokers to an evidence-based quitline service results in increased cessation. The benefit is largely due to patients in the referral condition receiving more external help than patients in the in-practice condition, as they received equivalent practice-based help. Where suitable services exist, we recommend that referral become the normative strategy for management of smoking cessation in general practice to complement any practice-based help provided.

MAKINGtheLINK: A school-based intervention to improve help-seeking for substance use problems

Many young people are reluctant to seek professional help for alcohol and other substance use problems, preferring to rely on family and friends. MAKINGtheLINK is a school‐based intervention that teaches adolescents how to help their peers overcome barriers to engaging with professional help. The current study examined the effect of the MAKINGtheLINK programme in a sample of 12‐ to 15‐year‐old students.

Improving help-seeking among adolescents: A school-based intervention.

Champion et al. (2015) recently reported findings supporting an Internet-based prevention programme targeting alcohol and cannabis use in early adolescence. They found increased alcohol and cannabis knowledge among 13-year-old students who completed the programme, as well as decreased intentions to use alcohol. Such prevention programmes are critical given high rates of risky drinking among young people, and the wide range of harms associated with early onset and/or regular drinking during adolescence (Lubman et al., 2007). Similarly, intervention efforts promoting help-seeking during this period are paramount, as many adolescents are reluctant to seek help for substance use problems despite the benefits of early treatment. Research examining help-seeking for mental health problems during adolescence has identified attitudes and beliefs that can act as barriers, including perceptions of stigma, fears about confidentiality, poor problem recognition and a belief that one should be able to sort out one’s own problems. Consequentially, many young people keep their problems to themselves, or turn to peers or key adults (e.g. parents) for help, despite evidence of poor mental health literacy among these groups (Gulliver et al., 2010). Developing programmes that address these barriers is therefore an important component of broader prevention efforts that aim to minimise the harms associated with adolescent drinking (Lubman et al., 2007). The MAKINGtheLINK: Seeking Help for Risky Drinking programme is a school-based intervention designed to address barriers and enablers to adolescent help-seeking, in order to promote help-seeking for alcohol-related problems before they reach clinical significance. The programme draws upon two well-validated models of behaviour change (the InformationMotivation-Behavioural Skills Model and Theory of Planned Behaviour) that have been previously utilised in school-based prevention programmes. We recently trialled the programme with 297 Grade 8 (aged 13–15) students from three Victorian schools. The programme was delivered over two sessions (3 hours total) during one week by an experienced teacher external to the school. An evaluation of the programme identified high levels of satisfaction. Preliminary results demonstrated increased knowledge, awareness of help-seeking options and confidence to seek help for alcohol problems (see Table 1). These data support the feasibility and acceptability of the MAKINGtheLINK programme within a school environment, and add to the evidence supporting early intervention within this context (Champion et al., 2015). Further research is needed to determine whether these findings translate into actual help-seeking behaviours, or whether the effects of the programme generalise to helpseeking for other disorders.

The impact of a GP clinical audit on the provision of smoking cessation advice

AimTo investigate whether participation in a clinical audit and education session would improve GP management of patients who smoke.MethodsGPs who participated in an associated smoking cessation research program were invited to complete a three-stage clinical audit. This process included a retrospective self-audit of smoking cessation management practices over the 6 months prior to commencing the study, attending a 2.5 hour education session about GP management of smoking cessation, and completion of a second retrospective self-audit 6 months later. Twenty-eight GPs completed the full audit and education process, providing information about their smoking cessation management with 1114 patients. The main outcome measure was changes in GP management of smoking cessation with patients across the audit period, as measured by the clinical audit tool.ResultsThe majority of GPs (57%) indicated that as a result of the audit process they had altered their approach to the management of patients who smoke. Quantitative analyses confirmed significant increases in various forms of evidence-based smoking cessation management practices to assist patients to quit, or maintain quitting across the audit period. However comparative analyses of patient data challenged these findings, suggesting that the clinical audit process had less impact on GP practice than suggested in GPs self-reported audit data.ConclusionThis study provides some support for the combined use of self-auditing, feedback and education to improve GP management of smoking cessation. However further research is warranted to examine GP- and patient-based reports of outcomes from clinical audit and other educational interventions.