In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial.
OBJECTIVE
GPs are an important source of smoking cessation advice. This research examined whether a model encouraging GP referral of patients who smoke to a specialist service would be acceptable and effective for increased smoking cessation when compared with a model of in-practice management.


METHODS
The study design was cluster randomized controlled trial. Practices were randomized to one of two interventions, at a rate of 1:2: (i) standard in-practice GP management or (ii) referral to a quitline service. The main outcome measures were sustained abstinence of >or=1 month duration at 3-month follow-up and >or=10 months duration at 12 months, using intention to treat analysis.


RESULTS
At 3-month follow-up, patients in the referral condition were twice as likely to report sustained abstinence than those in the in-practice condition [12.3% compared with 6.9%; odds ratio (OR) = 1.92 (95% confidence interval (CI) 1.17-3.13]. At 12-month follow-up, patients in the referral condition had nearly three times the odds of sustained abstinence [6.5% compared with 2.6%; OR = 2.86 (95% CI 0.94-8.71)]. The intervention effect was mediated by the amount of help received outside the practice.


CONCLUSIONS
This research provided evidence that GPs referring smokers to an evidence-based quitline service results in increased cessation. The benefit is largely due to patients in the referral condition receiving more external help than patients in the in-practice condition, as they received equivalent practice-based help. Where suitable services exist, we recommend that referral become the normative strategy for management of smoking cessation in general practice to complement any practice-based help provided.
Borland
Ron
R
VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Carlton, VIC, Australia. ron.borland@cancervic.org.au
Balmford
James
J
Bishop
Nicole
N
Segan
Catherine
C
Piterman
Leon
L
McKay-Brown
Lisa
L
Kirby
Catherine
C
Tasker
Caroline
C
D000293:Adolescent; D000328:Adult; D001315:Australia; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D013685:Telecommunications; D055815:Young Adult