Volume 182 - Issue 1
Web and telecounselling in Australia
Authors: Ron Borland and Catherine J Segan
Med J Aust 2005; 182 (1): 45-46. || doi: 10.5694/j.1326-5377.2005.tb06562.x
Published online: 3 January 2005
Published online: 3 January 2005
Ron Borland,* Catherine J Segan†
* Nigel Gray Distinguished Fellow, † Behavioural Scientist, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC 3053 ron.borlandATcancervic.org.au
To the Editor: The editorial on web and telephone counselling in Australia1 has the capacity to seriously mislead readers. It asserts:
Despite this extensive use, the review confirmed that no randomised controlled trials (RCTs) have been conducted of the efficacy of web or telecounselling either in Australia or internationally.1
The assertion was based on a review commissioned by the Commonwealth Department of Health and Ageing and from a review in the United Kingdom, but is simply not true. It may be true for services designed to deal with mental health problems, narrowly defined, but it is patently false if it is taken to include services to facilitate smoking cessation. We note that nicotine dependence is a recognised mental disorder,2 and thus, strictly speaking, even if the review asserted that it was restricted to mental health, it would still be wrong.
We do not know about the accuracy of the statements in relation to other drug use problems, but for smoking cessation there are a number of randomised trials of telephone-based systems,3 and at least two web-based resources are translations to the Internet of tailored computer advice services shown to be effective in RCTs.4,5 Both include Australian examples of RCTs. Our group demonstrated that the Quitline callback service as operated by Quit Victoria (phone 131 848) enhances cessation outcomes.6 Another study showed that an interactive personalised computer advice program called the QuitCoach (www.theQuitCoach.org.au) is effective in facilitating cessation, particularly by reducing relapse.4 It is currently available through the Department of Health and Ageing’s website at www.quitnow.info.au.
We wonder why this omission has happened. What makes a health issue as important as smoking so invisible? Are other drug and alcohol issues similarly invisible? Tobacco kills about 19 000 Australians each year, and disables many more. There is increasing evidence suggesting it plays an important aetiological role in the development of some mental disorders. Smoking rates among people with schizophrenia and depression are extraordinarily high.7-9 The Victorian Quitline has pioneered the integration of support for psychiatric conditions with smoking-cessation counselling,10 and, although this service has not yet been subject to outcome evaluation, it is apparent that it meets the proximal needs of both smokers with concurrent mental disorders and their carers.
Telephone and web-based services hold tremendous potential both as stand-alone services and as integrable components of comprehensive, coordinated care. High quality evaluations are required, and they need to be seen as an integral part of service delivery. People in other healthcare areas could learn a lot from what has been achieved in smoking cessation.
References
- Christensen H, Hocking BM, Smith D. Web and telecounselling in Australia [editorial]. Med J Aust 2004; 180: 604-605.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. Washington DC: APA, 1994: section 305.10. i1085689
- Stead LF, Lancaster T, Perera R. Telephone counselling for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. i1085692
- Borland R, Balmford J, Hunt D. The effectiveness of personally tailored computer-generated advice letters for smoking cessation. Addiction 2004; 99: 369-377. i1085694
- Etter JF, Pernerger. Effectiveness of a computer-tailored smoking cessation program: a randomized trial. Arch Intern Med 2001; 161: 2596-2601. i1085697
- Borland R, Segan CJ, Livingston PM, Owen N. The effectiveness of callback counselling for smoking cessation: a randomised trial. Addiction 2001; 96: 881-889. i1085699
- Wilhelm K, Mitchell P, Slade T, et al. Prevalence and correlates of DSM-IV major depression in an Australian national survey. J Affective Disord 2003; 75: 155-162. i1085701
- De Leon J. Smoking and vulnerability for schizophrenia. Schizophr Bull 1996; 22: 405-409. i1085704
- Davidson S, Judd F, Jolley D, et al. Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry 2001; 35: 196-202. i1085707
- Quitline guidelines: smoking cessation and mental illness. Melbourne: Victorian Smoking and Health Program, 2002. i1085709