A Randomised Control Led Trial of Weekly versus Basic Smoking Cessation Support in Primary Care

Background There is insufficient and conflicting evidence about whether more intensive behavioural support is more effective than basic behavioural support for smoking cessation and whether primary care nurses can deliver effective behavioural support. Methods In this randomised controlled trial in 26 UK general practices, 925 smokers of 10 or more cigarettes per day were randomly allocated to basic or weekly support. All participants were seen prior to quitting, telephoned around quit day, and seen one and four weeks after initial appointment (basic support). In weekly support, participants had an additional telephone call at 10 days and three weeks after initial appointment and an additional visit at 2 weeks to motivate adherence to nicotine replacement and renew quit attempts. 15mg/16 hour nicotine patches were given to all participants. The outcome was assessed by intention to treat analyses of the percentage confirmed sustained abstinence at 4, 12, 26, and 52 weeks after quit day. Results Of the 469 and 456 participants in the basic and weekly arms, the numbers (percentages) quit and the percentage difference (95% confidence intervals) were 105 (22.4), 102 (22.4), 0.1 (-5.3-5.5) at 4 weeks, 66 (14.1), 52 (11.4), -2.6 (-6.9-1.7) at 12 weeks, 50 (10.7), 40 (8.8), -1.9 (-5.7-2.0) at 26 weeks, and 36 (7.7), 30 (6.6), -1.1 (-4.4-2.3) at 52 weeks. Conclusions The absolute quit rates achieved are those expected from nicotine replacement alone, implying that neither basic nor weekly support were effective. Primary care smoking cessation treatment should provide pharmacotherapy with sufficient support only to ensure it is used appropriately and refer those in need of support to specialists.

[1]  R. West,et al.  Randomized controlled trial of a social support ('buddy') intervention for smoking cessation. , 2006, Patient education and counseling.

[2]  H. McRobbie,et al.  Effectiveness of specialist group treatment for smoking cessation vs. one-to-one treatment in primary care. , 2006, Addictive behaviors.

[3]  L. Bauld,et al.  The English smoking treatment services: one-year outcomes. , 2005, Addiction.

[4]  John Chesterman,et al.  The English smoking treatment services: short-term outcomes. , 2005, Addiction.

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

[6]  S. Shiffman,et al.  A meta-analysis of the efficacy of over-the-counter nicotine replacement , 2003, Tobacco control.

[7]  Timothy B Baker,et al.  Have we lost our way? The need for dynamic formulations of smoking relapse proneness. , 2002, Addiction.

[8]  F. Song,et al.  Cost-Effectiveness of Pharmacological Interventions for Smoking Cessation: A Literature Review and a Decision Analytic Analysis , 2002, Medical decision making : an international journal of the Society for Medical Decision Making.

[9]  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.

[10]  P. Gariti,et al.  Short- and long-term smoking cessation for three levels of intensity of behavioral treatment. , 2001, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[11]  S. Shiffman,et al.  Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review , 2001, Psychopharmacology.

[12]  Robert West,et al.  Smoking cessation guidelines for health professionals: an update , 2000, Thorax.

[13]  J. Susman,et al.  Transdermal nicotine therapy and primary care. Importance of counseling, demographic, and participant selection factors on 1-year quit rates. The Nebraska Primary Practice Smoking Cessation Trial Group. , 1998, Archives of family medicine.

[14]  R. West,et al.  A randomized controlled trial of a "buddy" systems to improve success at giving up smoking in general practice. , 1998, Addiction.

[15]  D. Mant,et al.  Randomised trial of nicotine patches in general practice: results at one year , 1994, BMJ.

[16]  J L Weissfeld,et al.  Treatment for cigarette smoking in a Department of Veterans Affairs outpatient clinic. , 1991, Archives of internal medicine.

[17]  P. Hajek.  Withdrawal-oriented therapy for smokers. , 1989, British journal of addiction.

[18]  M. Raw,et al.  Nicotine chewing gum in general practice: effect of follow up appointments. , 1985, British medical journal.

[19]  K. Fagerström.  Effects of nicotine chewing gum and follow-up appointments in physician-based smoking cessation. , 1984, Preventive medicine.

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

[21]  Josue P. Keely,et al.  Measures of abstinence in clinical trials: issues and recommendations. , 2003, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[22]  L. Stead,et al.  Group behaviour therapy programmes for smoking cessation. , 2000, The Cochrane database of systematic reviews.

[23]  G. Gustavsson,et al.  Dose effects and predictors of outcome in a randomized trial of transdermal nicotine patches in general practice. , 1995, Addiction.