A smoking cessation intervention in Australian General Practice: secondary analysis of a cluster randomised controlled trial

Abstract

Background: General practitioners have limited capacity to routinely provide smoking cessation support. New strategies are needed to reach all smokers within this setting. Aim: Evaluate the effect of a pharmacist-coordinated interdisciplinary smoking cessation intervention delivered in Australian general practice. Design: Secondary analysis of a cluster RCT conducted in 41 Australian general practices. Methods: 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 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 utilisation 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%) and no differences were observed in readiness to quit scores between groups. CO-validated abstinence rates were similar in those who completed HMR and six sessions of HomeBase compared 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.