Abstract
BackgroundGPs often lack time to provide intensive cessation advice for patients who smoke. This study aimed to determine the effectiveness of opportunistic referral of smokers by their GP for telephone cessation counselling by a trained nurse.MethodsAdult smokers (n = 318) attending 30 GPs in South Western Sydney, Australia were randomly allocated to usual care or referral to a telephone-based program comprising assessment and stage-based behavioural advice, written information and follow-up delivered by a nurse. Self-reported point prevalence abstinence at six and 12 months was compared between groups. Characteristics of patients who accepted and completed the intervention were investigated.ResultsOf 169 smokers randomised to the intervention, 76 (45%) consented to referral. Compared with smokers in 'pre-contemplation', those further along the stage-of-change continuum were significantly more likely to consent (p = 0.003). Those further along the continuum also were significantly more likely to complete all four calls of the intervention (OR 2.6, 95% CI: 0.8–8.1 and OR 8.6, 95% CI: 1.7–44.4 for 'contemplation' and 'preparation' respectively). At six months, there was no significant difference between groups in point prevalence abstinence (intention to treat) (9% versus 8%, p = 0.7). There was no evidence of differential intervention effectiveness by baseline stage-of-change (p = 0.6) or patient sex (p = 0.5). At 12 months, point prevalence abstinence in the intervention and control groups was 8% and 6% respectively (p = 0.6).ConclusionAcceptance of opportunistic referral for nurse delivered telephone cessation advice was low. This trial did not demonstrate improved quit rates following the intervention. Future research efforts might better focus support for those patients who are motivated to quit.Australian Clinical Trials Registry numberACTRN012607000091404
Highlights
general practitioner (GP) often lack time to provide intensive cessation advice for patients who smoke
Australian general practice provides a unique setting for the provision of smoking cessation advice as over 80% of the population visits a general practitioner (GP) in any given year [1]
Despite compelling evidence for their impact [3,4,5] and their unrivalled credibility as providers of health-related information [6], Australian GPs persistently exhibit low rates of detection of smokers and provision of evidence-based smoking cessation advice [7,8,9,10]. Those few randomised trials conducted in Australia to redress this gap between evidence and practice provide no clear-cut conclusions that any strategy will work to increase GPs' systematic identification of smokers or enhance rates of advice [11,12,13,14]
Summary
GPs often lack time to provide intensive cessation advice for patients who smoke. This study aimed to determine the effectiveness of opportunistic referral of smokers by their GP for telephone cessation counselling by a trained nurse. Despite compelling evidence for their impact [3,4,5] and their unrivalled credibility as providers of health-related information [6], Australian GPs persistently exhibit low rates of detection of smokers and provision of evidence-based smoking cessation advice [7,8,9,10]. A subgroup analysis of those 11 studies involving smokers in primary care or out-patient settings indicated that smoking intervention by nurses almost doubled the odds of success (OR 1.90, 95%CI 1.48–2.43) [17]. While a component of some interventions, telephone counselling was used only as an adjunct to face-to-face counselling and was not offered as a convenient medium for advice
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