What are the aims of the project?
We will assess trends in the delivery of interventions aimed at stopping smoking or reducing alcohol consumption in UK primary care.
We will determine what proportion of patients receive support to help them stop smoking and reduce their alcohol consumption. We will explore changes over the time and whether there were changes associated with the COVID-19 pandemic. We will assess differences by age, gender, region and socioeconomic status (a measure of inequality), by body mass index, in people with and without a history of major physical illness, and in people with and without a mental health condition.
Why is this research needed?
Although smoking rates have consistently declined in the UK in recent years, 1 in 7 adults still smoke regularly; in low-income groups and people with a mental health condition the rate is much higher. Overall alcohol consumption has fallen in the past two decades; however, around a quarter of adults regularly drink over the low-risk guidelines and most dependent drinkers are not accessing treatment. Health care professionals in primary care are well-placed to provide advice and support related to smoking and drinking, however, it is not known what proportion of patients receive this or how this has changed over time.
How will we carry out the research?
We will study anonymised general practice healthcare records to assess the proportion of patients receiving advice to quit smoking or reduce their drinking, prescriptions for stop smoking medication and referrals to specialist services.
Aim
To assess the delivery of stop smoking and alcohol interventions in primary care in the UK.
We will determine what proportion of patients have received support to stop smoking or reduce their alcohol consumption in primary care. We will assess changes over the time and differences by age, sex, region and socioeconomic status, by body mass index (BMI), in people with and without a history of major physical morbidity, and in people with and without a mental health condition. We will determine whether the proportion of patients receiving this type of support changed during the COVID-19 pandemic.
Why this research is needed
Although smoking rates have consistently declined in the UK in recent years, around 1 in 7 adults still smoke regularly. Overall alcohol consumption has fallen in the past two decades; however, around a quarter of adults regularly drink over the low-risk guidelines and the majority of dependent drinkers are not accessing treatment. The NHS Long Term Plan committed to an increase in NHS efforts in relation to prevention and inequalities. Health care professionals are well-placed to provide advice and support to help people stop smoking and reduce alcohol consumption; however, it is not known whether these opportunities are being maximised in primary care, and how approaches to tackling smoking and drinking in primary care have changed over time.
Design and methodology
We will conduct a population-based study using electronic medical records from CPRD. We will study the anonymised primary care records of millions of patients to calculate the proportion of patients receiving advice to quit smoking or reduce their alcohol consumption, prescriptions for stop smoking medication and referrals to specialist services over time. The impact of the COVID-19 pandemic will be analysed using interrupted time series analysis.
For the purposes of this proposal ‘delivery of smoking cessation and alcohol interventions’ is defined broadly to include advice giving (such as brief advice), referrals to alcohol/smoking cessation services outside of primary care and prescribing of smoking cessation medication. It also includes screening questionnaires such as AUDIT or FAST (for alcohol) or the Fagerström test for nicotine dependence (for smoking), because these are likely to be undertaken alongside advice in line with the questionnaire results. Recording of smoking or alcohol consumption status alone is not defined as an intervention but will be assessed as an indicator of how often these behaviours are mentioned in consultations. Given the increase in the use of electronic cigarettes in recent, we will also assess recording of e-cigarette use and explore recorded e-cigarette use in current, former and never smokers.
Smoking cessation interventions delivered to adults ages 18+ in primary care: detailed tobacco use assessment (e.g. Fagerström test); advice given; prescriptions for smoking cessation medication; referrals to smoking cessation services.
Alcohol interventions delivered to adults aged 18+ in primary care: detailed alcohol assessment (e.g. Alcohol Use Disorders Identification Test - AUDIT); advice given; referral to alcohol services.
Tessa Langley - Chief Investigator - University of Nottingham
Tessa Langley - Corresponding Applicant - University of Nottingham
Gemma Taylor - Collaborator - University of Bath
Ilze Bogdanovica - Collaborator - University of Nottingham
Tianqi Hu - Collaborator - University of Nottingham
Yue Huang - Collaborator - University of Nottingham
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation