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. 2023 Jan;32(1):72-79.
doi: 10.1136/tobaccocontrol-2021-056522. Epub 2021 Jun 3.

Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data

Dolly Baliunas  1   2   3 , Peter Selby  3   4   5   6 , Claire de Oliveira  7   8   9   10 , Paul Kurdyak  5   9   10   11 , Laura Rosella  3   9 , Laurie Zawertailo  4   12 , Longdi Fu  9 , Rinku Sutradhar  3   9   10   13
Affiliations

Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data

Dolly Baliunas et al. Tob Control. 2023 Jan.

Abstract

Background: No research has assessed the individual-level impact of smoking cessation treatment delivered within a general primary care patient population on multiple forms of subsequent healthcare service use.

Objective: We aimed to compare the rate of outpatient visits, emergency department (ED) visits and hospitalisations during a 5-year follow-up period among smokers who had and had not accessed a smoking cessation treatment programme.

Methods: The study was a retrospective matched cohort study using linked demographic and administrative healthcare databases in Ontario, Canada. 9951 patients who accessed smoking cessation services between July 2011 and December 2012 were matched to a smoker who did not access services, obtained from the Canadian Community Health Survey, using a combination of hard matching and propensity score matching. Outcomes were rates of healthcare service use from index date (programme enrolment or survey response) to March 2017.

Results: After controlling for potential confounders, patients in the overall treatment cohort had modestly greater rates of the outcomes: outpatient visits (rate ratio (RR) 1.10, 95% CI: 1.06 to 1.14), ED visits (RR 1.08, 95% CI: 1.03 to 1.13) and hospitalisations (RR 1.09, 95% CI: 1.02 to 1.18). Effect modification of the association between smoking cessation treatment and healthcare service use by prevalent comorbidity was found for outpatient visits (p=0.006), and hospitalisations (p=0.050), but not ED visits.

Conclusions: Patients who enrolled in smoking cessation treatment offered through primary care clinics in Ontario displayed a modest but significantly greater rate of outpatient visits, ED visits and hospitalisations over a 5-year follow-up period.

Keywords: cessation; health services; primary health care.

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Conflict of interest statement

Competing interests: DB reports receiving grant funding in the past 5 years from Pfizer, Ontario Ministry of Health and Long-Term Care, Canadian Institutes of Health Research (CIHR) and the Canadian Cancer Society Research Institute (CCSRI). PS reports receiving funding in the past 3 years from CCSRI, CIHR, Canadian Partnership Against Cancer, Centre for Addiction and Mental Health (CAMH), Health Canada, Medical Psychiatry Alliance, Ontario Ministry of Health and Long-Term Care, Ontario Neurotrauma Foundation and the Public Health Agency of Canada. PS also reports funding from the following commercial organisations: Patient-Centred Outcome Research Institute and Pfizer. PS has received honoraria in the past 3 years from University of Ottawa Heart Institute, Royal College of Physicians and Surgeons of Canada, Royal Victoria Regional Health Centre, Department of Family and Community Medicine at the University of Toronto, Northern Ontario School of Medicine, Canadian Partnership Against Cancer, Battle River Treaty 6 Healthcare, Lung Association of Nova Scotia, Exchange Summit, Toronto Public Health, Ontario Association of Public Health Dentistry and ECHO. PS has been retained as an expert witness by the Ontario and New Brunswick provincial governments in litigation against the tobacco industry. PS was a member and co-chaired the Ministry of Health’s Ontario Smoke Free Strategy cessation subcommittee. Through an open tender process, Johnson & Johnson, Novartis and Pfizer are vendors of record for providing free/discounted smoking cessation pharmacotherapy for research studies in which PS and/or LZ are principal or co-investigator. CdO reports receiving grant funding in the past 5 years from CIHR, University of Toronto, Medical Research Council, National Institutes of Health, CAMH, Alberta Innovates, Ontario Ministry of Health and Long-Term Care, Canadian Centre for Applied Research in Cancer Control and Ontario Mental Health Foundation. PK reports receiving grant funding in the past 5 years from CIHR and the Ontario Ministry of Health and Long-Term Care. LR reports receiving grant funding in the past 5 years from CIHR, New Frontiers in Research Fund, Canada Research Chairs and the Connaught Foundation. LZ reports receiving grant funding in the past 5 years from Pfizer, Ontario Ministry of Health and Long-Term Care, Health Canada, CIHR and CCSRI. LZ also received honoraria and travel funds from Pfizer and University of Ottawa Heart Institute. RS reports receiving funding in the past 5 years from CIHR, Terry Fox Research Institute, Garron Family Cancer Centre and Sick Kids Foundation, Canadian Society of Colon and Rectal Surgeons, Sunnybrook Foundation, Pediatric Oncology Group of Ontario, Ontario Institute for Cancer Research, PSI Foundation, C17 Research Network, Cancer Care Ontario, Canadian Centre for Applied Research in Cancer Control, Canadian Breast Cancer Foundation, Sunnybrook AFP Innovation Fund, CCSRI, Ministry of Health and Long-Term Care and the Ontario Medical Association. PS, LZ, PK, DB and CdO have been employed by CAMH in the past 36 months; results of this study may impact whether CAMH continues to receive funding from the Ministry of Health to administer the STOP programme. No other author has competing interests to declare.

Figures

Figure 1
Figure 1
Estimated mean cumulative number of outpatient visits, emergency department visits and hospitalisations in Ontario, Canada, between 2011 and 2017, in matched treatment and control cohorts, overall and stratified by sex. *Mean cumulative number of hospitalisations for women in the Smoking Treatment for Ontario Patients cohort at year 4.99. ED, emergency department.
Figure 2
Figure 2
Adjusted association between smoking cessation treatment and healthcare service use outcomes in Ontario, Canada, between 2011 and 2017, in matched treatment and control cohorts, overall and stratified by sex. Bolded RRs are significant at p<0.05. COPD, chronic obstructive pulmonary disease; ED, emergency department; RR, rate ratio.
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