Successes and Challenges of Implementing Tobacco Dependency Treatment in Health Care Institutions in England
Round 1
Reviewer 1 Report
This paper provides a good background review and an evaluation of developing and implementing a new clinical pathway for tobacco dependency. It also provides health economic data and the description, and discussion of barriers will be useful for other services considering implementing a similar pathway.
I would suggest adding a full description for the abbreviation VBA in the text. The paper mentions e-learning modules and training- how were these developed and made accessible to staff?; is there any data on how many staff accessed and received this training? This information may assist other health services when developing a similar pathway.
Author Response
I would suggest adding a full description for the abbreviation VBA in the text.
We have provided the full terminology of VBA in the abstract. We have also added the following text to section 5 'The CURE Project'
'Very brief advice (VBA) is a short healthcare professional-delivered intervention that focuses on the offer of help rather an instruction to stop smoking centred on three components: ask, advice, act. During VBA, the healthcare professional identifies that a person smokes, advises that the best chance of stopping smoking is with the help of medications and specialist support and then provides access to the medication and support.'
The paper mentions e-learning modules and training- how were these developed and made accessible to staff?; is there any data on how many staff accessed and received this training? This information may assist other health services when developing a similar pathway.
We have added the following text to section 5 'The CURE Project'
The CURE e-learning modules were uploaded to the Hospital’s employee training platform (the learning hub) and were recommended to all staff to complete. The e-learning modules covered the background knowledge & pathology of tobacco dependency, how to deliver VBA, the standardised prescribing protocol and provided video examples of consultations indifferent hospital settings between healthcare professional and patients that smoke illustrating these interventions. Over one thousand staff members completed the training during the pilot. The e-learning modules were also made available to any healthcare professional via The CURE website which provided certification on completion (https://thecureproject.co.uk/training/).
Reviewer 2 Report
Thank you for the opportunity to review this manuscript that describes the implementation of systemic tobacco treatment program in health care institutions in England. The CURE project is an impressive undertaking with impactful outcomes and these details on the approach and downstream benefits to patient and health system are important to disseminate as other healthcare systems adopt similar programs.
Abstract:
-Please spell out first instance of VBA
-There is a word missing or typo in the phrase "...during the hospital admission and can agree a support package..."
Section 2.
-There is a run-on sentence in the sentence that starts "At their peak in 2011/12..." The following sentence needs to be broken up into 2.
Section 3
-There is a word missing in the phrase starting "As this a new horizon..."
-The sentence that contains a numbered list at the end of the paragraph is misnumbered. #2 is listed twice.
Section 5
-When you say that varenicline was offered "alongside" NRT do you mean that it was offered as an alternative to dual NRT or it was offered in conjunction with NRT (as in, for concurrent use)? "Alongside" is not a very clear descriptor and I advise rephrasing this.
-Define first instance of VBA.
-is the 18% smoking rate consistent with the national prevalence of smoking in the UK or England?
-How was smoking abstinence defined?
General comments:
The manuscript would benefit from some points of comparison with other manuscripts describing similar inpatient tobacco treatment programs in other healthcare systems. The authors describe the OMSC in Section for but other similar systems could also be referenced. For example, see Palmer et al. 2021 (https://doi.org/10.1016/j.chest.2020.11.025). Describing your findings in terms of quit rates, pharmacotherapy uptake, etc. in the context of what other health systems have seen would help to benchmark/evaluate the CURE program. Granted, many of the articles in the review I referenced are in the US which has a different healthcare system approach than the UK NHS. But these points of comparison/highlighting differences may be helpful for other institutions considering similar programs.
Author Response
Please spell out first instance of VBA
This has been done.
-There is a word missing or typo in the phrase "...during the hospital admission and can agree a support package..."
We cant identify a typo or missing word in this sentence.
Section 2.
-There is a run-on sentence in the sentence that starts "At their peak in 2011/12..." The following sentence needs to be broken up into 2.
This has been corrected to two sentences
Section 3
-There is a word missing in the phrase starting "As this a new horizon..."
The missing 'is' has been added
-The sentence that contains a numbered list at the end of the paragraph is misnumbered. #2 is listed twice.
This has been corrected
Section 5
-When you say that varenicline was offered "alongside" NRT do you mean that it was offered as an alternative to dual NRT or it was offered in conjunction with NRT (as in, for concurrent use)? "Alongside" is not a very clear descriptor and I advise rephrasing this.
We have amended this to 'in conjunction with'
-Define first instance of VBA.
This has been amended
-is the 18% smoking rate consistent with the national prevalence of smoking in the UK or England?
This is higher than the overall UK smoking prevalence of 15% and this has been added to the text.
-How was smoking abstinence defined?
We have added this additional information to section 5:
Overall, 495 (21%) and 525 (22%) patients self-reported to be abstinent from tobacco at 4 weeks (of which 293 were chemically validated) and 12 weeks, respectively.
General comments:
The manuscript would benefit from some points of comparison with other manuscripts describing similar inpatient tobacco treatment programs in other healthcare systems. The authors describe the OMSC in Section for but other similar systems could also be referenced. For example, see Palmer et al. 2021 (https://doi.org/10.1016/j.chest.2020.11.025). Describing your findings in terms of quit rates, pharmacotherapy uptake, etc. in the context of what other health systems have seen would help to benchmark/evaluate the CURE program. Granted, many of the articles in the review I referenced are in the US which has a different healthcare system approach than the UK NHS. But these points of comparison/highlighting differences may be helpful for other institutions considering similar programs.
We have added the following text to section 5 which references the 2021 RCP report which tables the outcomes for OMSC, South Carolina, UK RCT and CURE for comparative review and demonstrates CURE delivering above these published outcomes.
The rates of uptake of pharmacotherapy, specialist support, follow-up and abstinence are greater than or equivalent to those seen in the OMSC, the UK RCT and a large study of hospital based tobacco dependency treatment in South Carolina of over 40,000 hospital admissions (24) suggesting this real-life services is at least replicating or enhancing the benefits seen in these published outcomes.
