The Impact of Digital Health on Smoking Cessation.

BACKGROUND: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients' quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation-relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. OBJECTIVE: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. METHODS: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. RESULTS: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. CONCLUSIONS: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources.

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking.

OBJECTIVE: The main objective is to transfer to clinical practice a new smoking cessation application ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. DESIGN: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SITE: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. INTERVENTION AND MAIN MEASUREMENT: Development of "Vive sin Tabaco"; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. RESULTS: The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. CONCLUSIONS: The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.

Corrigendum: Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis.

[This corrects the article DOI: 10.18332/tpc/127770.].

Cost-effectiveness analysis of text messaging to support health advice for smoking cessation.

BACKGROUND: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.

Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis.

INTRODUCTION: Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care. METHODS: In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted. RESULTS: A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis. CONCLUSIONS: According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis.

Effectiveness of a primary care-based group educational intervention in the management of patients with migraine: a randomized controlled trial.

AIM: The aim of this study was to assess the effectiveness of a primary care-based group educational intervention about concepts of pain neuroscience for the management of migraine compared to the routine medical care delivered to patients with this condition. BACKGROUND: The way pain is understood has been radically changed in recent decades, thanks to developments in the field of neuroscience. Thus, migraine may develop as a result of an exaggerated perception of threat that activates the pain neuromatrix, which might be modifiable, from a learning perspective, by adjusting the beliefs and behaviours that favour the onset of an attack. METHODS: A randomised controlled trial was carried out in five primary care health centres of Vitoria-Gasteiz (Basque Country, Spain). The follow-up period was 12 months. The main outcome measure was the reduction in days lost due to migraine-related disability according to the Migraine Disability Assessment Test (MIDAS) score. Secondary outcome measures included the intensity and frequency of the pain and the number of analgesic drugs taken in the previous three months. A positive response to treatment was considered when the MIDAS score decreased by at least 50% from baseline. FINDINGS: Days lost due to migraine-related disability decreased by at least 50% in 68.9% (n = 37) of patients in the intervention group and 34.6% of patients in the control group (n = 18) (P < 0.001). The intensity of the headache [odds ratio (OR) 9.116; P = 0.005] and the medication intake (OR 13.267; P < 0.001) were also significantly reduced with the intervention. CONCLUSIONS: The provision of suitable information through a group educational intervention delivered in primary care appears to be effective in preventing migraine attacks. Moreover, the intervention could offer a new cost-effective management alternative that seems to reduce the need for pharmacological treatment in patients with migraine.

Complexity of care processes in a radiation oncology service and its implications concerning the distribution of work and associated costs.

INTRODUCTION: Among several different instruments developed to compare the complexity of healthcare processes, relative value units (RVUs) are among the most well-known and widely used in hospitals, but despite being a recognized management tool, in our setting, the few studies published have been based on theoretical assumptions. Our objective was to assess the level of complexity of each process in our service and to determine the RVUs generated, in order to relate complexity and costs. METHODS: During 2014, data were retrospectively collected for 840 cancer patients from the Radiation Oncology Department, Araba University Hospital. Activity times and costs were subsequently assigned to calculate RVUs for each activity, cancer subtype and treatment option. RESULTS: The activity associated with the lowest cost, assigned an RVU of 1, was simulation (phase changes) in treatment, with an annual cost of €9933, while that with the highest cost, assigned the greatest number of RVUs, was administration of treatment by radiotherapy technicians (RTTs) (€633,754 and 63.80 RVUs). The care process that consumed the most resources was adjuvant treatment of breast cancer (€998,070), equivalent to 364.62 RVUs compared to the cheapest subtype of adjuvant treatments or 2440 RVUs compared to the care process that used the fewest resources overall. CONCLUSION: The most expensive activities are those which are the most complex or consume the most resources. Knowledge of RVUs may be employed to analyse our activity and assess the possibility of increasing the efficiency of our service without prejudicing quality.

Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial.

INTRODUCTION: Smoking remains a major risk factor for chronic diseases. Health advice is considered one of the most cost-effective interventions; however, changes produced by counseling tend not to persist over time, it is necessary to implement enforcement mechanisms. METHODS: Randomized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone (SMSalud®). Patients were randomized to one of two interventions: health advice (control group) or health advice and text messaging (intervention group). We included 320 smoker patients who met the inclusion criteria: being motivated, aged over 18 years, having a mobile phone, being able to read and send messages. Patients were excluded if they had a history of mental or behavioral disorders, or depression. The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test. RESULTS: By 6 months after the start of the program, 24.4% (39/160) of patients in the intervention group and 11.9% (19/160) of controls had stopped smoking (OR: 2.3; 95% CI: 1.3-4.3, p = .007). Patients with no dependence or mild dependence were more likely to stop (28.3%, 36/127 vs. 11.4%, 22/193; OR: 3.0, 95% CI: 1.7-5.5, p < .001). The rate of continuous abstinence at 12 months was 16.3% (26/160) in intervention group patients and 5.6% (9/160) in controls (OR: 3.2; 95% CI: 1.3-5.9).]. CONCLUSIONS: The combined program is effective for smoking cessation. Patients with less tobacco dependence have a higher probability of success. IMPLICATIONS: Health advice is effective for promoting changes in lifestyle but these changes do not persist over time, so we have to use strengthening mechanisms, as e-health, and specifically, mobile phone based interventions. SMSalud® is an innovate program that includes text messaging and health advice, and it's effective for smoking cessation. The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence.

[Registry of preventive activities in women: variability in Vizcaya, Spain]. / Variabilidad en Vizcaya del registro de las actividades preventivas en la mujer.

BACKGROUND: Several studies have reported that there is a lack of preventive activities performance in Primary Health Care, however in Vizcaya, the situation is not known, so, we decided determine the percentage of preventive activities carried out on women by primary care physicians which are recorded in the Electronic Health Record (Osabide), and analyze the characteristics which determine differences in registration between regions and physicians. METHODS: We conducted a cross-sectional study involving 425 women aged between 26 and 51 years who were to the general practitioners' consult at least twice, and who were again on April 28, 29 or 30, 2011. We colleted as primary variable the registries of contraceptives practices (group aged between 26 and 51 years), the registries of cervical cytologies during the last five years, as well as the registries of mammograms performed during the two last years, and compared the medical record between men and women practitioners, health regions and between areas with and without centers for women, using the chi-square statistic. RESULTS: In 139 (34.1%) of all women and in 99 (48.3%) of women aged between 26 and 51 years there was registry of cytologies and contraceptives practices respectively. The mammography performance was registered in 22 (10.7%) of women aged between 52 and 65 years. CONCLUSIONS: The registry of preventive activities on women is low. We have observed differences by practitioners' gender.