Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review

Carlos Martín Cantera, Elisa Puigdomènech, Jose Luis Ballvé, Olga Lucía Arias, Lourdes Clemente, Ramon Casas, Lydia Roig, Santiago Pérez-Tortosa, Laura Díaz-Gete, Sílvia Granollers, Carlos Martín Cantera, Elisa Puigdomènech, Jose Luis Ballvé, Olga Lucía Arias, Lourdes Clemente, Ramon Casas, Lydia Roig, Santiago Pérez-Tortosa, Laura Díaz-Gete, Sílvia Granollers

Abstract

Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers.

Design: A systematic review of randomised and non-randomised controlled trials was undertaken.

Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish.

Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted.

Results: Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences.

Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.

Keywords: PRIMARY CARE; health promotion; smoking cessation; systematic review.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Flow chart of article selection for the study.

References

    1. World Health Organization. WHO global report on mortality attributable to tobacco 2012.
    1. Gaziano TA, Galea G, Reddy KS. Chronic diseases 2—scaling up interventions for chronic disease prevention: the evidence. Lancet 2007;370:1939–46. 10.1016/S0140-6736(07)61697-3
    1. Kahn R, Robertson RM, Smith R et al. . The impact of prevention on reducing the burden of cardiovascular disease. Circulation 2008;118:576–85. 10.1161/CIRCULATIONAHA.108.190186
    1. Benowitz NL. Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. Prog Cardiovasc Dis 2003;46:91–111. 10.1016/S0033-0620(03)00087-2
    1. Fiore MC, Jaen CR, Baker TB et al. . Treating tobacco use and dependence: 2008 update US Public Health Service Clinical Practice Guideline executive summary. Respir Care 2008;53:1217–22. (accessed 11 Dec 2014).
    1. Tengs TO, Adams ME, Pliskin JS et al. . Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15:369–90. 10.1111/j.1539-6924.1995.tb00330.x
    1. Eckert T, Junker C. Motivation for smoking cessation: what role do doctors play? Swiss Med Wkly 2001;131:521–6.
    1. Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med 2000;9:426–33. 10.1001/archfami.9.5.426
    1. Ossip-Klein DJ, McIntosh S, Utman C et al. . Smokers ages 50+: who gets physician advice to quit? Prev Med 2000;31:364–9. 10.1006/pmed.2000.0721
    1. Stead LF, Buitrago D, Preciado N et al. . Physician advice for smoking cessation. Cochrane Database Syst Rev 2013;5:CD000165 10.1002/14651858.CD000165.pub4
    1. Russell MA, Wilson C, Taylor C et al. . Effect of general practitioners advice against smoking. BMJ 1979;2:231–5. 10.1136/bmj.2.6184.231
    1. Lemmens V, Oenema A, Knut IK et al. . Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev 2008;17:535–44. 10.1097/CEJ.0b013e3282f75e48
    1. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008;(2):CD000165 10.1002/14651858.CD000165.pub3
    1. Papadakis S, McDonald P, Mullen KA et al. . Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Prev Med 2010;51:199–213. 10.1016/j.ypmed.2010.06.007
    1. Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2012;10:CD008286 10.1002/14651858.CD008286.pub2
    1. Craig P, Dieppe P, Macintyre S et al. . Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655 10.1136/bmj.a1655
    1. Craig P, Dieppe P, Macintyre S et al. . Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud 2013;50:587–92. 10.1016/j.ijnurstu.2012.09.010
    1. Petticrew M, Anderson L, Elder R et al. . Complex interventions and their implications for systematic reviews: a pragmatic approach. J Clin Epidemiol 2013;66:1209–14. 10.1016/j.jclinepi.2013.06.004
    1. Dwamena F, Holmes-Rovner M, Gaulden CM et al. . Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev 2012;12:CD003267 10.1002/14651858.CD003267.pub2
    1. Grandes G, Sanchez A, Cortada JM et al. . Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers. BMC Health Serv Res 2008;8:213 10.1186/1472-6963-8-213
    1. Lau R, Stevenson F, Ong BN et al. . Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol. BMJ Open 2014;4:e005548 10.1136/bmjopen-2014-005548
    1. Wong G, Greenhalgh T, Westhorp G et al. . RAMESES publication standards: realist syntheses. J Adv Nurs 2013;69:1005–22. 10.1111/jan.12095
    1. Guise JM, Chang C, Viswanathan M et al. . Systematic reviews of complex multicomponent health care interventions. Research White Paper. AHRQ Publication No. 14-EHC003-EF Rockville, MD: Agency for Research and quality, 2014. . (accessed 11 Dec 2014).
    1. Jaakkimainen L, Schultz S, Klein-Geltink J et al. . Ambulatory physician care for adults. In: Jaakkimainen L, Upshur R, Klein-Geltink J, Leong A, Maaten S, Schultz S, Wang L, eds. Primary care in Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences, 2006:53–76.
    1. Zwar NA, Richmond RL. Role of the general practitioner in smoking cessation. Drug Alcohol Rev 2006;25:21–6. 10.1080/09595230500459487
    1. Moher D, Liberati A, Tetzlaff J et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–9, W64 10.7326/0003-4819-151-4-200908180-00135
    1. Hughes JR, Keely JP, Niaura RS et al. . Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 2003;5:13–25. 10.1080/1462220031000070552
    1. Shatenstein S. Smoking & Tobacco Abstracts & News (STAN Bulletin) 2014.
    1. Grandes G, Cortada JM, Arrazola A. An evidence-based programme for smoking cessation: effectiveness in routine general practice. Br J Gen Pract 2000;50:803–7.
    1. Cabezas C, Advani M, Puente D et al. . Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study). Addiction 2011;106:1696–706. 10.1111/j.1360-0443.2011.03491.x
    1. Puente D, Cabezas C, Rodriguez-Blanco T et al. , ISTAPS study group investigators. The role of gender in a smoking cessation intervention: a cluster randomized clinical trial. BMC Public Health 2011;11:369 10.1186/1471-2458-11-369
    1. Twardella D, Brenner H. Effects of practitioner education, practitioner payment and reimbursement of patients’ drug costs on smoking cessation in primary care: a cluster randomised trial. Tob Control 2007;16:15–21. 10.1136/tc.2006.016253
    1. Daughton D, Susman J, Sitorius M 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. Arch Fam Med 1998;7:425–30. 10.1001/archfami.7.5.425
    1. Lou PA, Zhu YA, Chen PP et al. . Supporting smoking cessation in chronic obstructive pulmonary disease with behavioral intervention: a randomized controlled trial. BMC Fam Pract 2013;14:91 10.1186/1471-2296-14-91
    1. Smit ES, Evers SM, de Vries H et al. . Cost-effectiveness and cost-utility of internet-based computer tailoring for smoking cessation. J Med Internet Res 2013;15:e57 10.2196/jmir.2059
    1. Secades-Villa R, Alonso-Perez F, Garcia-Rodriguez O et al. . Effectiveness of three intensities of smoking cessation treatment in primary care. Psychol Rep 2009;105:747–58. 10.2466/PR0.105.3.747-758
    1. Ramos M, Ripoll J, Estrades T et al. . Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial. BMC Public Health 2010;10:89 10.1186/1471-2458-10-89
    1. Torrecilla García M, Barrueco Ferrero M, Maderuelo Fernández J et al. [Tobacco detoxication at a primary care clinic: efficacy of medical counseling, minimal intervention and nicotine replacement therapy at the one-year follow-up]. Aten Primaria 2001;27:629–36. 10.1016/S0212-6567(01)78871-3
    1. Miller WR, Rollnick S. Motivational interviewing. New York: Preparing people for change Guilford, 2002.
    1. Prochaska JO, DiClemente CC. The transtheoretical approach. Handb Psychother Integr 2005;2:147–71.
    1. Becoña E, Vázquez FL. Does using relapse prevention increase the efficacy of a program for smoking cessation? An empirical study. Psychol Rep 1997;81:291–6. 10.2466/pr0.1997.81.1.291
    1. Cene CW, Yanek LR, Moy TE et al. . Sustainability of a multiple risk factor intervention on cardiovascular disease in high-risk African American families. Ethn Dis 2008;18:169–75.
    1. Wittchen HU, Hoch E, Klotsche J et al. . Smoking cessation in primary care—a randomized controlled trial of bupropione, nicotine replacements, CBT and a minimal intervention. Int J Methods Psychiatr Res 2011;20:28–39. 10.1002/mpr.328
    1. Zhu SH, Stretch V, Balabanis M et al. . Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. J Consult Clin Psychol 1996;64:202–11. 10.1037/0022-006X.64.1.202
    1. Aveyard P, Begh R, Parsons A et al. . Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction 2012;107:1066–73. 10.1111/j.1360-0443.2011.03770.x
    1. Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2005;(2):CD001292.
    1. Wu P, Wilson K, Dimoulas P et al. . Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006;6:300 10.1186/1471-2458-6-300
    1. Andersen S, Keller C, McGowan N. Smoking cessation: the state of the science. The utility of the transtheoretical model in guiding interventions in smoking cessation. Online J Knowl Synth Nurs 1999;6:9.
    1. Cahill K, Lancaster T, Green N. Stage-based interventions for smoking cessation. Cochrane Database Syst Rev. 2010;10:CD004492.
    1. Riemsma RP, Pattenden J, Bridle C et al. . Systematic review of the effectiveness of stage based interventions to promote smoking cessation. BMJ 2003;326:1175–7. 10.1136/bmj.326.7400.1175
    1. Tobacco Cochrane Addiction Group. Glossary 2014. (accessed 11 Dec 2014).
    1. West R, Hajek P, Stead L. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 2005;100:299–303. 10.1111/j.1360-0443.2004.00995.x
    1. Society for Research on Nicotine and tobacco Europe. SRNT-Europe chapter recommendations. Record keeping for smoking cessation services 2014. . (accessed 11 Dec 2014).

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