Short summary

Success rates of smoking cessation therapies to patients with mental illness by video consultants or by treatment in the community: A Randomized Controlled Trial

Rationale

Introduction

In the last decades, there has been a focus on physical health in patients with mental illness. The most important cause of excess mortality and physical illness in people with schizophrenia is cardiovascular disease (CVD), resulting in a much shorter life expectancy for patients with schizophrenia than the general population (3). The elevated risk rates of CVD can be explained by several factors, including unhealthy lifestyle, smoking, poor diet and sedentary behavior. Many of these risk factors are, modifiable and are important when aiming to reduce the risk of CVD. Smoking is probably the one single factor with the highest impact on reducing the life expectancies of patients with mental illness. This is both due to high injurious to health and due to high rates of smoking among patients with mental illness. In Denmark, it is found that among patients with persistent mental health problem 38.8% are smokers and among the general population the rate of smoking is 19.8%. International survey shows an even higher rate of smoking (55 %) among patients with a diagnose of schizophrenia, and 54 % of patients with a diagnose of bipolar disorders.

A Spanish survey found among almost 2000 patients treated for schizophrenia in outpatient clinics rates of smoking to be as high as 55.5% compared to 31.5% in the general Spanish population. Finally, in a systematic review from United States it is concluded that rates of smoking is the double among patients with mental illness compared to the general population. Furthermore, smoking is associated with increased risk of developing depression and this underlines the potentially harmful consequences of smoking for mental health and supports efforts to prevent and stop smoking.

Patients with mental illness thrive with psychiatric symptoms and may have problem in participating in ordinary smoking cession programs offered in the community. This might especially be true for patients with schizophrenia whom may have trouble changing their unhealthy lifestyle because of factors related to their illness, cognitive disturbances, negative and positive symptoms, and the side effect from treatment with psychotropic medicine. Patients with a diagnose of bipolar disorders and with a diagnose of depressing might also have challenging obstacles following a smoking cessation program successfully due to symptoms from and related to their psychiatric illness. Never the less many smokers living with mental illness are concerned about the impact of tobacco use on their health and finances and are motivated to address it, and hence treatment program should be available to smokers with mental illness.

Cigarette smoking can affect the pharmacokinetic and pharmacodynamic properties of psychotropic drugs. Cigarette smoking increasing drug clearance and necessitating higher medication doses. Studies has shown that patients on pharmacological treatment and nicotine replacement therapy (NRT) and bupropion, given separately or in combination, was effective and well tolerated in psychiatric populations. Smoking cessation therapy can be effective, but success is limited to treatment of patients who live near providing treatment centers, and hence some smokers are unable to access smoking cessation therapies due to location, financial limitations or transportation issues.

Videoconferencing addressing smoking cessation might be an ideal alternative to an ordinary face to face consultation at the clinic because the patients can access the treatment at home while having the face-to-face interaction. The effectiveness of a videoconferencing smoking cessation intervention was conducted in Canada for smokers in rural areas and the study found no difference in abstinence rates between the in-person and videoconferencing (tele-health) interventions (28% vs 26%). Another study in the United States compared videoconferencing and telephone-based smoking cessation interventions for smokers in primary care clinics, and abstinence rates were similar between the two approaches (10% vs 12%).

Psychiatric treatment through videoconference have shown equivalent efficacy to face-to-face psychiatric treatment and tele psychiatry can be an effective mean of delivering mental health services to psychiatric outpatients. Nevertheless, there is very limited research regarding the effectiveness of video conferencing in the management of smoking cessation to patients with mental illness, and more research is needed to further evaluate this. We want to develop a program of smoking cessation therapy in mental health settings and to assess its impact. The program is designed to provide flexible support tailored to the needs of the individual patients and conducted by health professionals who are experienced and knowledgeable in treating people with mental health problems.

Aims: We aimed to compare rates of smoking cessation in two interventions:

1.Daily video consultants tailored to the individual patients at the start of smoking cessation and the months after.

2. Treatment as usual (tau), consistent of smoking cessation treatment in the community by weekly consultants.

Description of the cohort

All patients diagnosed with schizophrenia, bipolar disorders and depression receiving treatment and care for mental illness in outpatient clinics will be eligible for inclusion in the study.

Data and biological material

Primary outcome is changes in number of cigarettes smoked pr. patients per day in mean at 6-month follow-up. Secondary outcome is abstinence from smoking at 6-month follow-up.

Other outcome data will include number of videoconference sessions and number of attendances at the weekly sessions in the community. Furthermore, data on age, sex, body mass index, diagnoses and use of psychotropic drugs will be extracted from the electronic patient records.

Collaborating researchers and departments

Sundhedsafdelingen, Vejle Kommune