Smoking cessation intervention in Australian general practice: a secondary analysis of a cluster randomised controlled trial

Background GPs have limited capacity to routinely provide smoking cessation support. New strategies are needed to reach all smokers within this setting. Aim To evaluate the effect of a pharmacist-coordinated interdisciplinary smoking cessation intervention delivered in Australian general practice. Design and setting Secondary analysis of a cluster randomised controlled trial (RCT) conducted in 41 Australian general practices. Method In all, 690 current smokers were included in this study: 373 from intervention clinics (n = 21) and 317 from control clinics (n = 18). A total of 166 current smokers had spirometry-confirmed chronic obstructive pulmonary disease (COPD). In the intervention clinics, trained pharmacists provided smoking cessation support plus Quitline referral. Control clinics provided usual care plus Quitline referral. Those with COPD in the intervention group (n = 84) were referred for home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase), which included further smoking cessation support. Outcomes included carbon monoxide (CO)-validated smoking abstinence, self-reported use of smoking cessation aids, and differences between groups in readiness-to-quit score at 6 months. Results Intention-to-treat analysis showed similar CO-validated abstinence rates at 6 months in the intervention (4.0%) and control clinics (3.5%). No differences were observed in readiness-to-quit scores between groups at 6 months. CO-validated abstinence rates were similar in those who completed HMR and at least six sessions of HomeBase to those with COPD in usual care. Conclusion A pharmacist-coordinated interdisciplinary smoking cessation intervention when integrated in a general practice setting had no advantages over usual care. Further research is needed to evaluate the effect of HMR and home-based pulmonary rehabilitation on smoking abstinence in smokers with COPD.

[1]  G. Russell,et al.  Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial , 2019, European Respiratory Journal.

[2]  G. Russell,et al.  Diagnosing COPD and supporting smoking cessation in general practice: evidence–practice gaps , 2018, The Medical journal of Australia.

[3]  G. Russell,et al.  Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial , 2017, BMJ Open.

[4]  A. Crockett,et al.  Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial. , 2016, Family practice.

[5]  A. Holland,et al.  Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial , 2016, Thorax.

[6]  R. Richmond,et al.  The experiences of smoking cessation among patients with chronic obstructive pulmonary disease in Australian general practice: a qualitative descriptive study. , 2016, Family practice.

[7]  B. Bonevski,et al.  Integrating smoking cessation into routine care in hospitals--a randomized controlled trial. , 2016, Addiction.

[8]  Hong Luo,et al.  Effectiveness of individual counseling for smoking cessation in smokers with chronic obstructive pulmonary disease and asymptomatic smokers , 2013, Experimental and therapeutic medicine.

[9]  R. Perera,et al.  Pharmacological interventions for smoking cessation: an overview and network meta-analysis. , 2013, The Cochrane database of systematic reviews.

[10]  B. Bonevski,et al.  A pharmacist-led system-change smoking cessation intervention for smokers admitted to Australian public hospitals (GIVE UP FOR GOOD): study protocol for a randomised controlled trial , 2013, Trials.

[11]  R. Richmond,et al.  Supporting smoking cessation: a guide for health professionals. , 2012 .

[12]  U. W. Jayasinghe,et al.  What predicts patient-reported GP management of smoking, nutrition, alcohol, physical activity and weight? , 2012, Australian journal of primary health.

[13]  Kenneth W Lin,et al.  Nicotine receptor partial agonists for smoking cessation. , 2011, American family physician.

[14]  R. Richmond,et al.  Quit in General Practice: a cluster randomised trial of enhanced in-practice support for smoking cessation , 2010, BMC family practice.

[15]  E. Coups,et al.  Receipt of Provider Advice for Smoking Cessation and Use of Smoking Cessation Treatments Among Cancer Survivors , 2009, Journal of General Internal Medicine.

[16]  K. Peters,et al.  The Handbook of Health Behavior Change , 2009 .

[17]  J. O'Loughlin,et al.  Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials , 2008, Canadian Medical Association Journal.

[18]  S. Shiffman,et al.  Use of smoking-cessation treatments in the United States. , 2008, American journal of preventive medicine.

[19]  D. Tinkelman,et al.  Offering free NRT through a tobacco quitline: impact on utilisation and quit rates , 2007, Tobacco Control.

[20]  Robert West,et al.  Outcome criteria in smoking cessation trials: proposal for a common standard. , 2005, Addiction.

[21]  L. Stead,et al.  Community pharmacy personnel interventions for smoking cessation. , 2004, The Cochrane database of systematic reviews.

[22]  M. Wakefield,et al.  Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign , 2003, Tobacco control.

[23]  W. Velicer,et al.  Biochemical verification of tobacco use and cessation. , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[24]  T. Coleman,et al.  Anti-smoking advice in general practice consultations: general practitioners' attitudes, reported practice and perceived problems. , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[25]  Andrew S. Boozary,et al.  The Commonwealth Fund , 1948, Nature.

[26]  Tim Lancaster,et al.  Individual behavioural counselling for smoking cessation. , 2017, The Cochrane database of systematic reviews.

[27]  Rashelle B Hayes,et al.  Addressing Tobacco Use and Dependence , 2013 .

[28]  Josue P. Keely,et al.  Shape of the relapse curve and long-term abstinence among untreated smokers. , 2004, Addiction.

[29]  J. Ward,et al.  Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers. , 2001, Family practice.