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

Rukshar K Gobarani; Nicholas A Zwar; Grant Russell; Michael J Abramson; Billie Bonevski; Anne E Holland; Eldho Paul; Narelle S Cox; Sally Wilson; Johnson George

doi:10.3399/BJGP.2020.0906

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

Br J Gen Pract. 2021 May 27;71(707):e458-e464. doi: 10.3399/BJGP.2020.0906. Print 2021 Jun.

Authors

Affiliations

¹ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences.
² Faculty of Health Sciences and Medicine, Bond University, Queensland, and School of Population Health, University of New South Wales, Sydney.
³ Department of General Practice, and director, Southern Academic Primary Care Research Unit, Department of General Practice.
⁴ School of Public Health and Preventive Medicine.
⁵ College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.
⁶ Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, and Department of Physiotherapy, Alfred Health, and Institute for Breathing and Sleep, Melbourne.
⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne.
⁸ Department of Allergy, Immunology and Respiratory Medicine, Monash University, and Institute for Breathing and Sleep, Melbourne.
⁹ Department of Infrastructure Engineering, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne.

Abstract

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.

Keywords: general practice; smoking cessation; tobacco use.

Publication types

Randomized Controlled Trial

MeSH terms

Australia
Behavior Therapy
Family Practice
General Practice*
Humans
Smoking Cessation*