The Effectiveness of Interventions to Increase the Delivery of Effective Smoking Cessation Treatments in Primary Care Settings – the ABCs

Aim: To summarize the evidence on the effectiveness of interventions to increase the likelihood of healthcare professionals initiating elements of the ABC approach for smoking cessation in primary care settings.

Conclusions and results: The ABC approach refers to interventions that increase the documentation of smoking status (Ask), provide brief advice to stop smoking (Brief advice), and offer/provide or make referrals to smoking cessation treatments or services (Cessation support), as compared to usual care.

The evidence base identified in this review provides good evidence on the effectiveness of a range of interventions aimed at increasing the likelihood of healthcare professionals initiating elements of the ABC approach in primary care settings (the review does not consider patient-level outcomes, ie, quit rates). The inherent assumption is that if people receive brief advice and support to quit, some will do so. Healthcare professionals were studied as individuals, in groups, or within an entire clinic or practice. Effective interventions included, training, multicomponent interventions, reminders, financial incentives, and audit and feedback. Sharing the responsibility for office-based smoking cessation activities among all staff appears to be a promising strategy.

Methods: A systematic method of literature searching and selection was employed in preparing this review. Our literature search used the following bibliographic databases: MEDLINE and EMBASE and, where applicable, the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), and other sources. Searches were limited to English language material published from 1990 onward. The searches were completed on November 24, 2008. We identified 464 citations, and after consideration of titles and abstracts using the study selection criteria, 130 full papers were retrieved and scrutinized in detail for possible inclusion in the review. As a result, 42 publications (including 5 review articles) were eligible for inclusion and were critically appraised.

Further research/reviews required: Further studies using well-operationalized baseline and outcome variables are needed to evaluate which combinations of intervention components are more or less effective, and what relative contributions individual components might make to programs implemented in New Zealand primary care settings.

Written by: David Brinson, HSAC, New Zealand