Abstract
Objectives: The COVID-19 pandemic has changed patterns of smoking, other substance use and other health-related behaviours, leading to a virtualisation of non-urgent medical care. In this study, we examine associated changes in outcomes of smoking-cessation treatment.
Design: Observational study.
Setting: Data are drawn from 221 physician-led primary care practices participating in a smoking cessation program in Ontario, Canada.
Participants: 43 509 patients (53% female), comprising 35 385 historical controls, 6109 people enrolled before the pandemic and followed up during it, and 1815 people enrolled after the pandemic began.
Intervention: Nicotine-replacement therapy with counselling.
Primary outcome measure: 7-day self-reported abstinence from cigarettes at a follow-up survey 6 months after entry.
Results: For people followed up in the 6 months (6M) after the pandemic began, quit probability declined with date of enrolment. Predicted probabilities were 31.2% (95% CI 30.0% to 32.5%) for people enrolled in smoking cessation treatment 6 months prior to the emergency declaration and followed up immediately after the state of emergency was declared, and 24.1% (95% CI 22.1% to 26.2%) for those enrolled in treatment immediately before the emergency declaration and followed up 6M later (difference=-6.5%, 95% CI -9.0% to -3.9%). Seasonality and total treatment use did not explain this decline.
Conclusion: The probability of successful smoking cessation following treatment fell during the pandemic, with the decline consistent with an effect of ‘exposure’ to the pandemic-era environment. As many changes happened simultaneously, specific causes cannot be identified; however, the possibility that virtual care has been less effective than in-person treatment should be explored.
Keywords: COVID-19; preventive medicine; substance misuse.
【저자키워드】 COVID-19, Preventive medicine, substance misuse, 【초록키워드】 Treatment, primary care, pandemic, therapy, COVID-19 pandemic, Substance use, outcome, smoking, seasonality, observational study, Probability, female, Patient, Virtual care, Follow-up, Canada, change, Care, 95% CI, enrolment, Health-related behaviours, controls, effective, enrolled, less, changes in, cause, changed, explain, declined, 【제목키워드】 Treatment, primary care, outcome, smoking, Effect,