Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial.
BACKGROUND
There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC).


METHODS
Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis.


METHODS
Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial.


METHODS
6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage.


METHODS
usual care.


METHODS
Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of <or= 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36.


CONCLUSIONS
The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline.
Cabezas
Carmen
C
Departament de Salut, Generalitat de Catalunya, Institut d'Investigació en Assistència Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. carmen.cabezas@gencat.cat
Martin
Carlos
C
Granollers
Silvia
S
Morera
Concepció
C
Ballve
Josep Lluis
JL
Zarza
Elvira
E
Blade
Jordi
J
Borras
Margarida
M
Serra
Antoni
A
Puente
Diana
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012107:Research Design; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult