Smoking Cessation In General Practice Research Articles

Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention?

INTRODUCTIONThis study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece.METHODSWe conducted a secondary analysis of data derived from a quasi-experimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery.RESULTSOur analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination.CONCLUSIONSProviders are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.

Pharmacogenetics of smoking cessation in general practice: results from the patch II and patch in practice trials.

Cigarette smoking remains the leading cause of preventable death worldwide. However, the efficacy of available first-line therapies remains low, particularly in primary care practice where most smokers seek and receive treatment. These observations reinforce the notion that 'one size fits all' smoking cessation therapies may not be optimal. Therefore, a translational research effort was launched by the Imperial Cancer Research Fund (later Cancer Research UK) General Practice Research Group, who led a decade-long research enterprise that examined the influence of pharmacological hypothesis-driven research into genetic influences on drug response for smoking cessation with transdermal nicotine replacement therapy in general practice. New and previously published smoking cessation genetic association results of 30 candidate gene polymorphisms genotyped for participants in two transdermal nicotine replacement clinical trials based in UK general practices, which employed an intention to analyze approach. By this high bar, one of the polymorphisms (COMT rs4680) was robust to correction for multiple comparisons. Moreover, future research directions are outlined; and lessons learned as well as best-practice models for designing, analyzing, and translating results into clinical practice are proposed. The results and lessons learned from this general practice-based pharmacogenetic research programme provide transportable insights at the transition to the second generation of pharmacogenetic and genomic investigations of smoking cessation and its translation to primary care.

In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial

GPs are an important source of smoking cessation advice. This research examined whether a model encouraging GP referral of patients who smoke to a specialist service would be acceptable and effective for increased smoking cessation when compared with a model of in-practice management. The study design was cluster randomized controlled trial. Practices were randomized to one of two interventions, at a rate of 1:2: (i) standard in-practice GP management or (ii) referral to a quitline service. The main outcome measures were sustained abstinence of >or=1 month duration at 3-month follow-up and >or=10 months duration at 12 months, using intention to treat analysis. At 3-month follow-up, patients in the referral condition were twice as likely to report sustained abstinence than those in the in-practice condition [12.3% compared with 6.9%; odds ratio (OR) = 1.92 (95% confidence interval (CI) 1.17-3.13]. At 12-month follow-up, patients in the referral condition had nearly three times the odds of sustained abstinence [6.5% compared with 2.6%; OR = 2.86 (95% CI 0.94-8.71)]. The intervention effect was mediated by the amount of help received outside the practice. This research provided evidence that GPs referring smokers to an evidence-based quitline service results in increased cessation. The benefit is largely due to patients in the referral condition receiving more external help than patients in the in-practice condition, as they received equivalent practice-based help. Where suitable services exist, we recommend that referral become the normative strategy for management of smoking cessation in general practice to complement any practice-based help provided.

Proactive interventions for smoking cessation in general medical practice: a quasi‐randomized controlled trial to examine the efficacy of computer‐tailored letters and physician‐delivered brief advice*

AimsTo test the efficacy of (i) computer-generated tailored letters and (ii) practitioner-delivered brief advice for smoking cessation against an assessment-only condition; and to compare both interventions directly.DesignQuasi-randomized controlled trial.SettingA total of 34 randomly selected general practices from a German region (participation rate 87%).ParticipantsA total of 1499 consecutive patients aged 18–70 years with daily cigarette smoking (participation rate 80%).InterventionsThe tailored letters intervention group received up to three individualized personal letters. Brief advice was delivered during routine consultation by the practitioner after an onsite training session. Both interventions were based on the Transtheoretical Model of behaviour change.MeasurementsSelf-reported point prevalence and prolonged abstinence at 6-, 12-, 18- and 24-month follow-ups.FindingsAmong participants completing the last follow-up, 6-month prolonged abstinence was 18.3% in the tailored letters intervention group, 14.8% in the brief advice intervention group and 10.5% in the assessment-only control group. Assuming those lost to follow-up to be smokers, the rates were 10.2%, 9.7% and 6.7%, respectively. Analyses including all follow-ups confirmed statistically significant effects of both interventions compared to assessment only. Using complete case analysis, the tailored letters intervention was significantly more effective than brief advice for 24-hour [odds ratio (OR) = 1.4; P = 0.047] but not for 7-day point prevalence abstinence (OR = 1.4; P = 0.068) for prolonged abstinence, or for alternative assumptions about participants lost to follow-up.ConclusionsThe study demonstrated long-term efficacy of low-cost interventions for smoking cessation in general practice. The interventions are suitable to reach entire populations of general practices and smoking patients. Computer-generated letters are a promising option to overcome barriers to provide smoking cessation counselling routinely.

Effects of practitioner education, practitioner payment and reimbursement of patients’ drug costs on smoking cessation in primary care: a cluster randomised trial

Objective: To evaluate new strategies to enhance the promotion of smoking cessation in general practice. Design: Cluster randomised trial, 2×2 factorial design. Setting: 82 medical practices in Germany, including 94...

Smoking cessation in general practice: The effects of a quitline

This cross-sectional study assessed changes between 1999 and 2003 in attitudes among Swedish general practitioners (GPs) toward smoking cessation activities and also assessed the effect of a nationwide quitline on GPs' smoking cessation activities. A random sample of 621 Swedish GPs answered a questionnaire mailed to their home addresses in spring 2003. When possible, the results of the present study were compared with results from a similar study conducted in 1999. Main outcome measures were GPs' self-reported activities, perceived barriers to engaging in smoking cessation, and referrals to the quitline. Between 1999 and 2003, GPs increased their overall smoking cessation activities and were more aware of the complexity of smoking cessation support. Significantly more GPs experienced smoking cessation support as "too time consuming" and preferred to refer smokers to counselors specializing in smoking cessation. GPs referring patients to the quitline were more likely to be active in other smoking cessation activities. One out of five GPs had advised their patients to use oral smokeless tobacco as a means to stop smoking. A paradigm shift regarding awareness of the complexity of smoking cessation support may be ongoing amongst Swedish GPs. The nationwide smoking cessation quitline appears to have had a positive effect on GPs' engagement in smoking cessation.

Pragmatic, observational study of bupropion treatment for smoking cessation in general practice

Background: Cigarette smoking remains the single largest cause of premature death in the United Kingdom. As part of the government’s national service framework for coronary heart disease, smoking cessation forms...

419: Strategies to Promote Smoking Cessation in General Practice: Results of a Cluster-Randomized Trial

419: Strategies to Promote Smoking Cessation in General Practice: Results of a Cluster-Randomized Trial

Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness

The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners (GPs), practice nurses, and others to offer advice and support to smokers in their efforts to stop. However, GPs are not allowed to write NHS prescriptions for nicotine-replacement therapy, even though this is the only effective pharmaceutical treatment available in the UK. We estimated the cost-effectiveness, for the NHS, of allowing GPs to prescribe transdermal nicotine patches for up to 12 weeks. We used data from a randomised, placebo-controlled efficacy trial of nicotine patches and a survey of associated resource use in 30 GP surgeries in 15 English counties. We calculated the health benefit of nicotine-patch treatment in number of life years that would be saved by stopping smoking at various ages, and used an abstinence-contingent treatment model to calculate the incremental cost per life year saved by GP counselling with nicotine-patch treatment over GP counselling alone. Cost effectiveness was assessed on the basis that GPs would provide repeat NHS prescriptions for up to 12 weeks if the treatment was proving successful. If GPs were allowed to prescribe transdermal nicotine patches on the NHS, for up to 12 weeks, the incremental cost per life year saved would be: Pound Sterling 398 per person younger than 35 years; Pound Sterling 345 for those aged 35-44 years; Pound Sterling 432 for those aged 45-54 years; and Pound Sterling 785 for those aged 55-65 years. The low cost per life year saved would make GP intervention against smoking a cost-effective life-saving treatment. The priniciples of the government White Paper could be cost-effectively extended into general practice to reduce smoking and smoking-related illnesses.

Weight change after smoking cessation in general practice.

To examine weight change among patients attending a smoking cessation program administered by general practitioners. Body weight and smoking level were measured at the initial assessment and at a six-month follow-up visit. Pretreatment measures of demographic, attitudinal and smoking-related variables were examined for relationship to weight gain. A total of 235 patients who were part of a smoking cessation study in Sydney. Change in weight over six months. Abstainers (n = 52) gained an average of 4.0 kg, significantly more than continuing smokers who gained an average of 1.2 kg. Among abstainers, only self-ratings of good health predicted weight gain. Results indicate that weight gain among general practice patients following smoking cessation is similar to that in other research settings.