Smoking Cessation In Primary Care Research Articles

Healthcare providers’ perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study

BackgroundPost-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The “Picking up the PACE (Promoting and Accelerating Change through Empowerment)” study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results.MethodsTwenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network’s Hexagon Tool. The data were analyzed using the framework’s standard analysis approach.ResultsMost healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients’ needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators.ConclusionThere appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients’ it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention.Name of the registryClinicaltrials.gov.Trial registration numberNCT04223336.Date of registration7 January 2020 Retrospectively registered.URL of trial registry recordhttps://classic.clinicaltrials.gov/ct2/show/NCT04223336.

Smoking cessation in primary care.

Smoking cessation in primary care.

Approaches to Tobacco Use and Smoking Cessation in Primary Care: 5A and 5R Strategies

Approaches to Tobacco Use and Smoking Cessation in Primary Care: 5A and 5R Strategies

Implementing smoking cessation in routine primary care-a qualitative study.

The use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice. To explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work. A qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers. Informants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools. Implementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.

Managing smoking cessation in primary care

Smoking remains a significant preventable cause of serious chronic diseases. Smokers should be advised about quitting at every opportunity, using very brief advice as a quick and reliable method to instigate empathetic support and understanding, which encourages smokers to consider quitting. Nicotine replacement therapy, especially combining a long-release and short-release formulae, should be the first step in the use of pharmaceutical aids. Ideally, heavily dependent smokers should also be prescribed varenicline, but this is currently unavailable in the UK. An alternative is bupropion, which should be a consideration. However, it is less effective, with more side effects. Electronic cigarettes have been recommended as a suitable quitting aid, and also for harm reduction in those who are not yet ready to stop smoking.

RTMS for smoking cessation in primary care

rTMS for smoking cessation in primary care

The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial.

BackgroundPeople who smoke have other risk factors for chronic diseases, such as low levels of physical activity and poor diet. Clinical decision support systems (CDSSs) might help health care practitioners integrate interventions for diet and physical activity into their smoking cessation programming but could worsen quit rates.ObjectiveThe aims of this study are to assess the effects of the addition of a CDSS for physical activity and diet on smoking cessation outcomes and to assess the implementation of the study.MethodsWe conducted a pragmatic hybrid type I effectiveness-implementation trial with 232 team-based primary care practices in Ontario, Canada, from November 2019 to May 2021. We used a 2-arm randomized controlled trial comparing a CDSS addressing physical activity and diet to treatment as usual and used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to measure implementation outcomes. The primary outcome was self-reported 7-day tobacco abstinence at 6 months.ResultsWe enrolled 5331 participants in the study. Of these, 2732 (51.2%) were randomized to the intervention group and 2599 (48.8%) to the control group. At the 6-month follow-up, 29.7% (634/2137) of respondents in the intervention arm and 27.3% (552/2020) in the control arm reported abstinence from tobacco. After multiple imputation, the absolute group difference was 2.1% (95% CI −0.5 to 4.6; F1,1000.42=2.43; P=.12). Mean exercise minutes changed from 32 (SD 44.7) to 110 (SD 196.1) in the intervention arm and from 32 (SD 45.1) to 113 (SD 195.1) in the control arm (group effect: B=−3.7 minutes; 95% CI −17.8 to 10.4; P=.61). Servings of fruit and vegetables changed from 2.64 servings to 2.42 servings in the intervention group and from 2.52 servings to 2.45 servings in the control group (incidence rate ratio for intervention group=0.98; 95% CI 0.93-1.02; P=.35).ConclusionsA CDSS for physical activity and diet may be added to a smoking cessation program without affecting the outcomes. Further research is needed to improve the impact of integrated health promotion interventions in primary care smoking cessation programs.Trial RegistrationClinicalTrials.gov NCT04223336 https://www.clinicaltrials.gov/ct2/show/NCT04223336International Registered Report Identifier (IRRID)RR2-10.2196/19157

Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial

BackgroundWhile quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care.MethodsThis is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05.DiscussionGP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions.Trial registrationClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.

Can nicotine replacement therapy be personalized? A statistical learning analysis

BackgroundTechnology has made automated care personalization practical, but useful personalization requires information about systematic differences between individuals in the effectiveness of different interventions. Here, we used observational data to search for differences in smoking cessation treatment outcomes associated with interactions between participant characteristics and different types and doses of nicotine replacement therapy (NRT). MethodsWe analyzed 33,077 enrollments in a large primary care smoking cessation program in Ontario, Canada. We considered 10 types and combinations of NRT, as well as the provided daily dose of nicotine. We used ridge regression to fit one main effects model and one model including all possible interactions between these measures and a range of demographic and health variables. We then compared the predictive accuracy of these models in a held-out 25 % testing subset using areas under the receiver operating characteristic curve (AUROC) and the integrated discrimination improvement index (IDI). We used random forest multiple imputation to address missing data. ResultsThe model including main effects only modestly predicted quit success at 6 months (AUROC = 0.646, 95 % CI = 0.631, 0.660). The final model with all interactions had essentially identical performance (AUROC = 0.640, 95 % CI = 0.626, 0.654; IDI = −0.0066). ConclusionWe found no evidence of meaningful interactions between treatment outcomes and participants' characteristics, NRT type, or NRT dose. Although data are observational, these findings suggest that the effectiveness of different types and doses of NRT do not vary substantially with participant characteristics. Personalization based on the overall likelihood of quit success, or using genetic or other biological data, remains possible.

Formative Provider Testing of a New Encounter Decision Aid for Smoking Cessation: Questionnaire Study.

BackgroundSmoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments.ObjectiveWe aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care.MethodsWe developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians.ResultsIn all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments.ConclusionsThe overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.

We are all choice architects: using behavioral economics to improve smoking cessation in primary care.

We are all choice architects: using behavioral economics to improve smoking cessation in primary care.

Counselling on smoking cessation in primary care from the population perspective in two regions of the Russian Federation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This study was conducted as part of the International Project on Cardiovascular Disease in Russia (IPCDR). IPCDR is supported by the Wellcome Trust [100217/Z/12]; the Norwegian Ministry of Health; the Norwegian Institute of Public Health; UiT, The Arctic University of Norway. Background. Smoking is one of the main risk factors for noncommunicable disease, which account for about 71% of the world"s population mortality. The prevalence of smoking in Russia is 27.3% totally and average 37% in males. One of the effective strategies smoking cessation is counselling in primary care facilities. Purpose. Identify the frequency of counseling on smoking cessation in primary care from the population perspective in two regions of Russia and determine the socio-economic and behavioural factors associated with receiving advice on smoking. Methods. The study was carried out within the framework of the international scientific project "Know your heart" (2015-2018). A representative sample of residents of Novosibirsk and Arkhangelsk aged 35 to 69 years was included in the study. The frequency of getting advice on smoking cessation was analyzed among those respondents who have contacts with the healthcare system over the last year (n = 3320) and among those who are currently smokers (n = 738). Data were analyzed using SPSS v.17 and Jamovi v.1.6.8. Factors associated with the chance of getting were analyzed by binomial logistic regression analysis. The reliability of regression model was assessed using ROC analysis. Results. Only 491 responders (66.5%) who smoked and visited primary care facilities received advice on smoking cessation. Females were significantly less likely to receive counselling compared with males (Odds Ratio (OR) = 0.41; 95% Confidence Interval (CI) 0.27-0.60; p˂0.001), people aged 65+ compared with age group 35-44 (OR = 0.37; 95% CI 0.16-0.82; p = 0.014), working persons compared with pensioners (OR = 0.58; 95% CI 0.35-0.98; p = 0.041). Obesity (BMI = 30.0-34.9) significantly increased the chance of getting advice on smoking cessation compared with normal body mass (OR = 2.05; 95% CI 1.19-3.52; p = 0.010), as well as visits the GP (for visiting GP 1-2 times a year: OR = 1.66; 95% CI 1.12-2.46; p = 0.011; for visiting GP 3-4 times a year: OR = 3.35; 95% CI 1.76-6.36; p˂0.001; for visiting GP≥5 times a year: OR = 2.94; 95% CI 1.41-6.13; p = 0.004). Other types of contacts with healthcare system included in the analysis (visits to other specialists, hospitalizations, ambulance calls during previous 12 months) were not associated with the chance of getting advice on smoking quitting. The accuracy of the obtained regression model was 62.13 (p˂0.001). ROC analysis showed that the sensitivity of the model is 89.2%, specificity is 31.6%, the area under the ROC curve (AUC) is 0.710 ± 0.020 (95% CI 0.67-0.75) that corresponds to the good quality of the model. Conclusion. The healthcare system needs to be more proactive in conducting counseling on smoking cessation. Gender, age, BMI, visit to a GP were associated with receiving counseling on smoking cessation. More attention should be paid to women, elderly people and men with normal BMI. Other specialists except GPs also should pay attention to the patients smoking habits and give advice. Abstract Figure. ROC curve

Effectiveness of Combining Feedback about Lung Age or Exhaled Carbon Monoxide Levels with Very Brief Advice (VBA) and Support for Smoking Cessation in Primary Care Compared to Giving VBA and Support Alone – Protocol for a Randomized Controlled Trial withi

INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. Тo date, there are no studies investigating smoking cessation treatment in Republic of Macedonia.&#x0D; METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking &gt;10 cigarettes per day, aged &gt;35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group – VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patients’ and GPs’ experience and the acceptability of the study intervention by interview.&#x0D; DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia.&#x0D; TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638).

How To Support Smoking Cessation In Primary Care And The Community: A Systematic Review Of Interventions For The Prevention Of Cardiovascular Diseases.

IntroductionSmoking is a major risk factor for cardiovascular diseases (CVDs) and for many types of cancers. Despite recent policies, 1.1 billion people are active smokers and tobacco is the leading cause of mortality and illness throughout the world. The aim of this work was to identify smoking cessation interventions which could be implemented in primary care and/or at a community level.MethodsA systematic review of CVDs prevention guidelines was realized using the ADAPTE Process. These were identified on G-I-N and TRIP databases. Additionally, a purposive search for national guidelines was successfully undertaken. Guidelines focusing on non-pharmacological lifestyle interventions, published or updated after 2011, were included. Exclusion criteria were specific populations, management of acute disease and exclusive focus on pharmacological or surgical interventions. After appraisal with the AGREE II tool, high-quality guidelines were included for analysis. High-grade recommendations and the supporting bibliographic references were extracted. References had to be checked in detail where sufficient information was not available in the guidelines.ResultsNine hundred and ten guidelines were identified, 47 evaluated with AGREE II and 26 included. Guidelines recommended that patients quit smoking and that health care professionals provided advice to smokers but failed to propose precise implementation strategies for such recommendations. Only two guidelines provided specific recommendations. In the guideline bibliographic references, brief advice (BA) and multiple session strategies were identified as effective interventions. These interventions used Prochaska theory, motivational interviewing or cognitive-behavioral therapies. Self-help documentation alone was less effective than face-to-face counseling. Community-based or workplace public interventions alone did not seem effective.DiscussionBehavioral change strategies were effective in helping patients to give up smoking. BA alone was less effective than multiple session strategies although it required fewer resources. Evidence for community-based interventions effectiveness was weak, mainly due to the lack of robust studies.

The effect of a clinical decision support system on prompting an intervention for risky alcohol use in a primary care smoking cessation program: a cluster randomized trial

BackgroundClinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt.MethodsThis was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method.ResultsTwo hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88–1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71–1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01–2.16, p = 0.045).ConclusionA CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients’ acceptance of the resource.Trial registrationThis trial is registered with ClinicalTrials.gov, number NCT03108144, registered on April 11, 2017, “retrospectively registered”.

Effectiveness of individual and group multicomponent interventions for smoking cessation in primary care: a quasi-experimental study.

The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice. To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices. A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients. The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065-3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006-3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126-4.980, P < 0.05) were significantly associated with smoking cessation. Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment.

Intervenciones efectivas para la deshabituación tabáquica en Atención Primaria

Objective: to find the scientific evidence on effective interventions for smoking cessation in Primary Care. Method: a narrative review through a bibliographic search in different databases: PubMed, Cinahl, Cochrane Plus, Scielo, Clinical Key, Cuiden, Google Scholar and ScienceDirect. The MeSH and DeSH descriptors, or free terms used, depending on the database, were “Atención Primaria de Salud” (Primary Health Care) and “cese del uso de tabaco” (tobacco use cessation), combined with the boolean operator “Y” (AND). The search was conducted in Spanish and English, within the publication period from 2007 and 2017. The inclusion criteria were: original articles, reviews or expert panels, about interventions promoting smoking cessation for the adult population in the Primary Care setting. The exclusion criteria were: research protocols, editorials, letters, and opinion articles. Results: fourteen (14) articles were selected. Four types of intervention were identified: group, individual, pharmacological and mixed. Group interventions reported a 41.1% rate of abstinence per year. Within individual interventions, the 5 A’s model was used, with variability in its use; a reduction in smoking between 15 and 40% was reported. In the pharmacological interventions, it was observed that those patients using nicotine patches and/or inhaler presented higher adherence than those using chewing-gum, and that drug combination was more effective and caused fewer side effects. In mixed interventions, the abstinence was >50%.Conclusions: the combination of behavioural and pharmacological therapies offers encouraging results. No method of reference can be pointed at for the confirmation of abstinence applied from Primary Care.

Missed teachable moments for promoting smoking cessation in primary care: a qualitative study in Armenia

Missed teachable moments for promoting smoking cessation in primary care: a qualitative study in Armenia

Association between race and receipt of counselling or medication for smoking cessation in primary care.

Previous evidence of race disparities in smoking cessation treatment has been limited to mostly survey studies which increase the potential for recall bias. We examined if African American versus white patients in primary care are less likely to receive any treatment or if race disparities are specific to the type of treatment offered using data pulled from a large electronic health record system. Medical record data from 3510 white and 2707 African American patients were available from primary care encounters between 2008 and 2015 and was used to define smoking status, cessation treatments (counselling and medication), and covariates. The association between race and type of smoking cessation treatment offered was measured by logistic regression models before and after adjusting for covariates. Smoking cessation counselling was offered to 9.3% of African American and 7.8% of white patients, and a prescription for smoking cessation medication was offered to 12.3% of African American and 16.4% of white patients. After adjusting for covariates in logistic regression models, whites were significantly less likely than African American patients to receive smoking cessation counselling [odds ratio (OR) = 0.81; 95% confidence interval (CI) = 0.65-0.99] and were significantly more likely to receive a prescription for a smoking cessation medication (OR = 1.23; 95% CI = 1.03-1.47). Less than 20% of smokers received any type of therapy to assist in smoking cessation. We observed a race disparity in type of smoking cessation therapy provided to white and African American primary care patients. Further research is needed to increase treatment rates and eliminate disparities.

The effectiveness of varenicline versus nicotine replacement therapy on long-term smoking cessation in primary care: a prospective cohort study of electronic medical records.

BackgroundThere is limited evidence about the effectiveness of varenicline and nicotine replacement therapy (NRT) for long-term smoking cessation in primary care, or whether the treatment effectiveness differs by socioeconomic position (SEP). Therefore, we estimated the long-term effectiveness of varenicline versus NRT (> 2 years) on smoking cessation, and investigated whether effectiveness differs by SEP.MethodsThis is a prospective cohort study of electronic medical records from 654 general practices in England, within the Clinical Practice Research Datalink, using three different analytical methods: multivariable logistic regression, propensity score matching and instrumental variable analyses. Exposure was prescription of varenicline versus NRT, and the primary outcome was smoking cessation at 2 years’ follow-up; outcome was also assessed at 3, 6, and 9 months, and at 1 and 4 years after exposure. SEP was defined using the Index of Multiple Deprivation.ResultsAt 2 years, 28.8% (N = 20 362/70 610) of participants prescribed varenicline and 24.3% (N = 36 268/149 526) of those prescribed NRT quit; adjusted odds ratio was 1.26 [95% confidence interval (CI): 1.23 to 1.29], P < 0.0001. The association persisted for up to 4 years and was consistent across all analyses. We found little evidence that the effectiveness of varenicline differed greatly by SEP. However, patients from areas of higher deprivation were less likely to be prescribed varenicline; adjusted odds ratio was 0.91 (95% CI: 0.90 to 0.92), P < 0.0001.ConclusionsPatients prescribed varenicline were more likely to be abstinent up to 4 years after first prescription than those prescribed NRT. In combination with other evidence, the results from this study may be used to update clinical guidelines on the use of varenicline for smoking cessation.