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Cochrane Database of Systematic Reviews

Intervenciones de cambios de sistemas para el abandono del hábito de fumar

Información

DOI:
https://doi.org/10.1002/14651858.CD010742.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 10 febrero 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Tabaquismo

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Dennis Thomas

    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia

  • Michael J Abramson

    Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia

  • Billie Bonevski

    School of Medicine & Public Health, University of Newcastle, Newcastle, Australia

  • Johnson George

    Correspondencia a: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia

    [email protected]

Contributions of authors

All authors contributed to conceptualising and designing the review.

DT was involved in developing search strategies, conducting searches, screening articles, extracting data and writing the first and subsequent drafts of the review.

JG was involved in developing search strategies, screening articles, extracting data, reviewing and revising drafts.

BB was involved in developing search strategies, reviewing and revising drafts. BB also acted as an arbiter to resolve any disagreements between DT and JG regarding study methodology.

MJA was involved in developing search strategies, reviewing and revising drafts. MJA also acted as an arbiter to resolve any disagreements between DT and JG regarding study methodology.

All authors reviewed and approved the final manuscript.

Declarations of interest

JG, MJA and BB have received an investigator‐initiated grant from Pfizer for the “Give Up For Good” study which aims to evaluate the effectiveness of a pharmacist‐driven system‐change smoking cessation programme at three Australian hospitals. They also hold an investigator‐initiated research grant from Boehringer‐Ingelheim for an unrelated study.
MJA has also undertaken an unrelated consultancy for AstraZeneca. He received an honorarium for speaking at a Novartis Respiratory Symposium, assistance with attendance at the European Respiratory Society Congress from Boehringer‐Ingelheim and the World Health Summit from Sanofi.
BB is also supported by an Australian National Health and Medical Research Council Career Development Fellowship (GNT1063206) and a Faculty of Health and Medicine, University of Newcastle Gladys M Brawn Career Development fellowship.

DT has no conflict of interest to declare.

Acknowledgements

We thank Lindsay Stead and Nicola Lindson‐Hawley of the Cochrane Tobacco Addiction Group for their assistance throughout the review process.

Version history

Published

Title

Stage

Authors

Version

2017 Feb 10

System change interventions for smoking cessation

Review

Dennis Thomas, Michael J Abramson, Billie Bonevski, Johnson George

https://doi.org/10.1002/14651858.CD010742.pub2

2013 Sep 10

System change interventions for smoking cessation

Protocol

Dennis Thomas, Michael J Abramson, Billie Bonevski, Johnson George

https://doi.org/10.1002/14651858.CD010742

Differences between protocol and review

We used the current 'Risk of bias' criteria table embedded in RevMan, rather than the previous version specified in the protocol.
We have changed the classification of secondary outcomes, by combining the health professional and patient‐level outcomes and reporting them as 'outcome of care'.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Summary of findings for the main comparison. System change interventions for tobacco control

System change interventions for tobacco control (primary cessation outcome)

Patient or population: Smokers
Settings: Any healthcare delivery setting
Intervention: System change

Outcomes*

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Cessation outcome
Self‐reported/verified abstinence
Follow‐up: 6 to 24 months

7142
(4 studies)

⊕⊝⊝⊝
very low1,2

2 of the 4 studies significantly favoured the intervention. Mixed effect and low quality evidence preclude drawing conclusions

NB. Illustrative comparative risks and relative effects columns have been removed, as only narrative syntheses were conducted due to the presence of significant heterogeneity among studies.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Self‐reported abstinence was verified only in one study, and one study reported higher dropout rate in one group.
2High clinical heterogeneity among included studies; outcomes are measured at different time points, and in different settings.

Figuras y tablas -
Summary of findings for the main comparison. System change interventions for tobacco control
Ir a la tabla de la revisión
Summary of findings 2. System change interventions for tobacco control

System change interventions for tobacco control (secondary outcomes)

Patient or population: Smokers
Settings: Any healthcare delivery setting
Intervention: System change

Outcomes*

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Provision of cessation counselling
Proportion of smokers counselled to quit

10,949
(4 studies)

⊕⊕⊝⊝
low1,2,3

3 of the 4 studies significantly favoured the intervention. The low quality of the evidence precludes drawing conclusions

Asking about tobacco use
Proportion of smokers asked about tobacco use

2615
(3 studies)*

⊕⊕⊝⊝
low1,3

2 of the 3 studies significantly favoured the intervention. The low quality of the evidence precludes drawing conclusions

Provision of cessation advice
Proportion of smokers advised to quit

3003
(3 studies)*

⊕⊕⊝⊝
low1,3

2 of the 3 studies significantly favoured the intervention. The low quality of the evidence precludes drawing conclusions

Quitline referral
Proportion of smokers referred to quitline

3006
(3 studies)*

⊕⊝⊝⊝
very low1,3

All 3 studies significantly favoured the intervention. However, the low quality of the evidence precludes drawing conclusions

Quitline enrolment
Proportion of smokers enrolled in quitline

1191
(2 studies)*

⊕⊝⊝⊝
very low1,3

Both studies significantly favoured the intervention. However, the low quality of the evidence precludes drawing conclusions

Prescription of NRT or other pharmacotherapy
Proportion of smokers received NRT prescription

2615
(2 studies)

⊕⊕⊝⊝
low1,3

Of the 2 studies, 1 significantly favoured the intervention. Mixed effect and low‐quality evidence preclude drawing conclusions

NB. Illustrative comparative risks and relative effects columns have been removed, as only narrative syntheses were conducted due to the presence of significant heterogeneity among studies

*We have not included data from one study as the data were collected as counts (no denominator)

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Included studies had high risk of detection bias.
2Large difference in effect size between studies.
3High clinical heterogeneity among included studies; different settings, providers and intervention.

Figuras y tablas -
Summary of findings 2. System change interventions for tobacco control
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Table 1. Components of interventions in included studies

Identification/ documentation of smoking status

Smoking cessation Training/ resources/feedback to providers

Dedicated staff to support cessation activities

Policies to improve access to cessation interventions

Free smoking cessation treatment from the organization

Reimburse clinicians for providing smoking cessation support

Cabezas 2011

Yes

Yes

No

No

Yes

No

Gordon 2010

Yes

Yes

No

No

Yes

No

Joseph 2004

Yes

Yes

No

Yes

Yes

No

Little 2009

Yes

Yes

No

Yes

Yes

No

Patwardhan 2012

Yes

Yes

No

Yes

Yes

No

Rothemich 2010

Yes

Yes

No

Yes

Yes

No

Winickoff 2013

Yes

Yes

No

Yes

Yes

No
Figuras y tablas -
Table 1. Components of interventions in included studies
Ir a la tabla de la revisión
Table 2. Summary of secondary outcomes

Study

Asking about tobacco use

Documentation of smoking status

Advice to quit

Counselling to quit

Initiation of NRT or other pharmacotherapy

Quitline referral

Quitline enrolment

Cabezas 2011

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Gordon 2010

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Not assessed

Joseph 2004

No difference between groups (76.0% vs 74.3%; P = 0.71)

Favoured intervention (60.7% vs 67.0%; P < 0.001)

Not assessed

No difference between groups (73.9% vs 71.8%; P = 0.60)

No difference between groups (14.7% vs 18.0%; P = 0.38)

Not assessed

Not assessed

Little 2009

Not assessed

Not assessed

Not assessed

Favoured intervention (69% vs 3%; P < 0.01)

Not assessed

Not assessed

Not assessed

Patwardhan 2012*

Favoured intervention (636 vs 5; P < 0.001)

Not assessed

Favoured intervention (25 vs 3; P < 0.01)

Not assessed

Not assessed

Favoured intervention (240 vs 85; P = 0.02)

Favoured intervention (81 vs 8; P < 0.001)

Rothemich 2010

Not assessed

Not assessed

No difference between groups (58.2% vs 55.3%; P = 0.39).

Favoured intervention (34.4% vs 27.7%; P = 0.001)

Not assessed

Favoured intervention (21.4% vs 8.7%; P < 0.001)

Not assessed

Winickoff 2013

Favoured intervention (59.4% vs 32.6%; P < 0.001)

Not assessed

Favoured intervention (50.5% vs 26.9%; P < 0.001).

Favoured intervention (54.7% vs 19.2%; P < 0.001)

Favoured intervention (18.5% vs 2.4%; P < 0.001)

Favoured intervention (37.2% vs 9.3%; P < 0.001)

Favoured intervention (4.1% vs 1.1%; P < 0.01)

*data collected as counts (no denominator)
Figuras y tablas -
Table 2. Summary of secondary outcomes
Ir a la tabla de la revisión