Smoking cessation in primary care: implementation of a proactive telephone intervention

Abstract

Purpose: To perform a smoking cessation intervention by a nurse practitioner in a primary care setting and assess its effectiveness.

Data sources: The intervention developed was an operationalization of the five As from the U.S. Department of Health and Human Services' updated Clinical Practice Guideline: Treating Tobacco Use and Dependence. Data were generated from a two-group controlled intervention that compared adult smokers who either received or did not receive an intensive proactive telephone intervention focused on cessation.

Conclusions: The intervention group showed movement across the stages of change, lower nicotine dependence, and increased confidence to quit. Also, 19% quit smoking and were abstinent at the end of study; none in the control group achieved abstinence. Quit rates were similar to those of other studies. The statistically necessary sample size was not attained, highlighting recruitment difficulties in smoking cessation studies. For a pilot study, the sample size was acceptable.

Implications for practice: Measuring stage of change and nicotine dependence can assist clinicians in implementing cessation strategies. Although effective, a provider may find the intervention too intensive to employ with more than one patient at a time. This intervention should be evaluated with smokers ready to make a quit attempt.

Keywords: Smoking cessation; clinical practice guidelines; nurse practitioners; primary care; stages of change.