title: Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review.
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.
  
  
  METHODS
  A systematic review of randomised and non-randomised controlled trials was undertaken.
  
  
  METHODS
  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.
authors.affiliation: Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín Cantera
authors.affiliation: Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Puigdomènech
authors.affiliation: Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ballvé
authors.affiliation: Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Olga Lucía
authors.initials: OL
authors.lastname: Arias
authors.affiliation: Centro de Salud Santo Grial, Huesca, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Clemente
authors.affiliation: Centre d'Atenció Primària (CAP) Sant Antoni, Institut Català de la Salut (ICS), Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Casas
authors.affiliation: Centre d'Atenció Primària (CAP) La Garriga, Institut Català de la Salut (ICS), La Garriga, Barcelona, Spain Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Spain.
authors.forename: Lydia
authors.initials: L
authors.lastname: Roig
authors.affiliation: Centre d'Atenció Primària (CAP) La Llagosta, Institut Català de la Salut (ICS), La Llagosta, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Tortosa
authors.affiliation: Centre d'Atenció Primària (CAP) la Sagrera, Institut Català de la Salut (ICS), Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Díaz-Gete
authors.affiliation: Centre d'Atenció Primària (CAP) Esplugues de Llobregat, Institut Català de la Salut (ICS), Esplugues de Llobregat, Spain.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Granollers
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention
keywords: PRIMARY CARE; health promotion; smoking cessation; systematic review