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Keywords:

  • Counselling;
  • multi-level analysis;
  • preventive health services;
  • smoking cessation;
  • therapist variability;
  • treatment outcome

Abstract

Aims

A network of Stop Smoking Services has been set up within the National Health Service (NHS) in England. The services deliver a combination of behavioural support and medication. It is important to establish the degree of variability in quit rates attributable to differences between individual practitioners, to gauge the scope for improvement by training and professional support. The aim of the present analysis was to examine how far short-term quit rates depend on the practitioner delivering the intervention after adjusting for potential confounding variables.

Design

Observational study using routinely collected data.

Setting

Thirty-one NHS Stop Smoking Services in England.

Participants

Data from 46 237 one-to-one treatment episodes (supported quit attempts) delivered by specialist practitioners.

Measurements

Three-level logistic regression models were fitted for carbon monoxide (CO)-validated short-term (4-week) quit rates. Models adjusted for age, gender, exemption from prescription charges, medication and intervention setting for each treatment episode, number of clients for each practitioner and economic deprivation at the level of the Stop Smoking Service. Secondary analyses included (i) the Heaviness-of-Smoking Index (HSI) as predictor and (ii) 4-week quit rates whether or not confirmed by CO.

Findings

Differences between individual specialist practitioners explained 7.6% of the variance in CO-verified quit rates after adjusting for client demographics, intervention characteristics and practitioner and service variables (P < 0.001). HSI had little impact on this figure; in quits not necessarily validated by CO, practitioners explained less variance.

Conclusions

Individual stop smoking practitioners appear to differ to a significant degree in effectiveness. It is important to examine what underlies these differences in order to improve selection, training and professional development.