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. 2015 Oct 1;5(10):e008807.
doi: 10.1136/bmjopen-2015-008807.

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

Carlos Martín Cantera  1 , Elisa Puigdomènech  2 , Jose Luis Ballvé  3 , Olga Lucía Arias  3 , Lourdes Clemente  4 , Ramon Casas  5 , Lydia Roig  6 , Santiago Pérez-Tortosa  7 , Laura Díaz-Gete  8 , Sílvia Granollers  9
Affiliations

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

Carlos Martín Cantera et al. BMJ Open. .

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.

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Figures

Figure 1
Figure 1
Flow chart of article selection for the study.
See this image and copyright information in PMC

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