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Meta-Analysis
. 2021 Sep 6;9(9):CD011556.
doi: 10.1002/14651858.CD011556.pub2.

Strategies to improve smoking cessation rates in primary care

Nicola Lindson  1 , Gillian Pritchard  2   3 , Bosun Hong  4 , Thomas R Fanshawe  1 , Andrew Pipe  2 , Sophia Papadakis  2
Affiliations
Meta-Analysis

Strategies to improve smoking cessation rates in primary care

Nicola Lindson et al. Cochrane Database Syst Rev. .

Abstract

Background: Primary care is an important setting in which to treat tobacco addiction. However, the rates at which providers address smoking cessation and the success of that support vary. Strategies can be implemented to improve and increase the delivery of smoking cessation support (e.g. through provider training), and to increase the amount and breadth of support given to people who smoke (e.g. through additional counseling or tailored printed materials).

Objectives: To assess the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings. To assess whether any effect that these interventions have on smoking cessation may be due to increased implementation by healthcare providers.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries to 10 September 2020.

Selection criteria: We included randomized controlled trials (RCTs) and cluster-RCTs (cRCTs) carried out in primary care, including non-pregnant adults. Studies investigated a strategy or strategies to improve the implementation or success of smoking cessation treatment in primary care. These strategies could include interventions designed to increase or enhance the quality of existing support, or smoking cessation interventions offered in addition to standard care (adjunctive interventions). Intervention strategies had to be tested in addition to and in comparison with standard care, or in addition to other active intervention strategies if the effect of an individual strategy could be isolated. Standard care typically incorporates physician-delivered brief behavioral support, and an offer of smoking cessation medication, but differs across studies. Studies had to measure smoking abstinence at six months' follow-up or longer.

Data collection and analysis: We followed standard Cochrane methods. Our primary outcome - smoking abstinence - was measured using the most rigorous intention-to-treat definition available. We also extracted outcome data for quit attempts, and the following markers of healthcare provider performance: asking about smoking status; advising on cessation; assessment of participant readiness to quit; assisting with cessation; arranging follow-up for smoking participants. Where more than one study investigated the same strategy or set of strategies, and measured the same outcome, we conducted meta-analyses using Mantel-Haenszel random-effects methods to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs).

Main results: We included 81 RCTs and cRCTs, involving 112,159 participants. Fourteen were rated at low risk of bias, 44 at high risk, and the remainder at unclear risk. We identified moderate-certainty evidence, limited by inconsistency, that the provision of adjunctive counseling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost-free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. There was also moderate-certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow-up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants). There was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies we judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty. We downgraded the evidence due to imprecision, inconsistency and risk of bias across these comparisons. There was some indication that provider training increased the delivery of smoking cessation support, along with the provision of adjunctive counseling and cost-free medications. However, our secondary outcomes were not measured consistently, and in many cases analyses were subject to substantial statistical heterogeneity, imprecision, or both, making it difficult to draw conclusions. Thirty-four studies investigated multicomponent interventions to improve smoking cessation rates. There was substantial variation in the combinations of strategies tested, and the resulting individual study effect estimates, precluding meta-analyses in most cases. Meta-analyses provided some evidence that adjunctive counseling combined with either cost-free medications or provider training enhanced quit rates when compared with standard care alone. However, analyses were limited by small numbers of events, high statistical heterogeneity, and studies at high risk of bias. Analyses looking at the effects of combining provider training with flow sheets to aid physician decision-making, and with outreach facilitation, found no clear evidence that these combinations increased quit rates; however, analyses were limited by imprecision, and there was some indication that these approaches did improve some forms of provider implementation.

Authors' conclusions: There is moderate-certainty evidence that providing adjunctive counseling by an allied health professional, cost-free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. There is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, we rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. Further studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting. Such studies should be cluster-randomized to account for the implications of implementation in this particular setting. Due to substantial variation between studies in this review, identifying optimal characteristics of multicomponent interventions to improve the delivery of smoking cessation treatment was challenging. Future research could use component network meta-analysis to investigate this further.

Trial registration: ClinicalTrials.gov NCT01155973.

PubMed Disclaimer

Conflict of interest statement

NL: none known

TF: none known

BH: none known

GP: none known

AP is employed by the University of Ottawa Heart Institute, which has received educational and research grants from Pfizer Canada, the Heart and Stroke Foundation of Ontario, Public Health Agency of Canada, Ontario Ministry of Health and Long Term Care. AP has received consulting fees and speaker honoraria from Pfizer, Johnson and Johnson, Merck, Glaxo‐Smith Kline. AP is an inventor of the Ottawa Model for Smoking Cessation. A commercial organization uses the Ottawa Model for Smoking Cessation program, and the inventors have received royalty payments in the past, through the University of Ottawa Heart Institute.

GW: none known

SP is an inventor of the Ottawa Model for Smoking Cessation. A commercial organization uses strategies informed by the Ottawa Model for Smoking Cessation program, and SP has received royalty payments in the past, through the University of Ottawa Heart Institute.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 1 Adjunctive counseling (patient‐level), outcome: 1.1 Long‐term abstinence (subgrouped by single vs. multicomponent intervention type).
4
4
Funnel plot of comparison: 2 Cost‐free medications (patient‐level), outcome: 2.1 Long‐term abstinence.
1.1
1.1. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 1: Long‐term abstinence (subgrouped by single vs. multicomponent intervention type)
1.2
1.2. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 2: Long‐term abstinence (subgrouped by provider)
1.3
1.3. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 3: Long‐term abstinence (subgrouped by mode)
1.4
1.4. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 4: Long‐term abstinence (subgrouped by intensity)
1.5
1.5. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 5: Advise rates
1.6
1.6. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 6: Assistance rates
1.7
1.7. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 7: Arrange follow‐up support rates
1.8
1.8. Analysis
Comparison 1: Adjunctive counseling (patient‐level), Outcome 8: Quit attempts
2.1
2.1. Analysis
Comparison 2: Cost‐free medications (patient‐level), Outcome 1: Long‐term abstinence (subgrouped by single vs. multicomponent intervention type)
2.2
2.2. Analysis
Comparison 2: Cost‐free medications (patient‐level), Outcome 2: Quit attempts
3.1
3.1. Analysis
Comparison 3: Biomedical feedback (patient‐level), Outcome 1: Long‐term abstinence (subgrouped by type)
4.1
4.1. Analysis
Comparison 4: Tailored print materials (patient‐level), Outcome 1: Long‐term abstinence (subgrouped by theoretical basis)
4.2
4.2. Analysis
Comparison 4: Tailored print materials (patient‐level), Outcome 2: Quit attempts
5.1
5.1. Analysis
Comparison 5: Provider training (provider‐level), Outcome 1: Long‐term abstinence
5.2
5.2. Analysis
Comparison 5: Provider training (provider‐level), Outcome 2: Asking rates
5.3
5.3. Analysis
Comparison 5: Provider training (provider‐level), Outcome 3: Advise rates
5.4
5.4. Analysis
Comparison 5: Provider training (provider‐level), Outcome 4: Assistance rates
5.5
5.5. Analysis
Comparison 5: Provider training (provider‐level), Outcome 5: Arrange follow‐up support rates
5.6
5.6. Analysis
Comparison 5: Provider training (provider‐level), Outcome 6: Quit attempts
6.1
6.1. Analysis
Comparison 6: Provider incentives (provider‐level), Outcome 1: Long‐term abstinence
7.1
7.1. Analysis
Comparison 7: Adjunctive counseling + cost‐free meds versus standard care, Outcome 1: Long‐term abstinence
8.1
8.1. Analysis
Comparison 8: Adjunctive counseling + provider training versus standard care, Outcome 1: Long‐term abstinence
9.1
9.1. Analysis
Comparison 9: Provider training + flow sheet versus standard care, Outcome 1: Long‐term abstinence
9.2
9.2. Analysis
Comparison 9: Provider training + flow sheet versus standard care, Outcome 2: Asking rates
9.3
9.3. Analysis
Comparison 9: Provider training + flow sheet versus standard care, Outcome 3: Assistance rates
9.4
9.4. Analysis
Comparison 9: Provider training + flow sheet versus standard care, Outcome 4: Arrange follow‐up support rates
10.1
10.1. Analysis
Comparison 10: Provider training + outreach facilitation versus standard care, Outcome 1: Long‐term abstinence
10.2
10.2. Analysis
Comparison 10: Provider training + outreach facilitation versus standard care, Outcome 2: Asking rates
10.3
10.3. Analysis
Comparison 10: Provider training + outreach facilitation versus standard care, Outcome 3: Assistance rates
10.4
10.4. Analysis
Comparison 10: Provider training + outreach facilitation versus standard care, Outcome 4: Arrange follow‐up support rates
10.5
10.5. Analysis
Comparison 10: Provider training + outreach facilitation versus standard care, Outcome 5: Quit attempts
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011556

References

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    1. Lancaster T, Dobbie W, Vos K, Yudkin P, Murphy M, Fowler G. Randomized trial of nurse-assisted strategies for smoking cessation in primary care. British Journal of General Practice 1999;49(440):191-4. [PMID: ] - PMC - PubMed
Lasser 2017 {published data only}
    1. Lasser KE, Quintiliani LM, Truong V, Xuan Z, Murillo J, Jean C, et al. Effect of patient navigation and financial incentives on smoking cessation among primary care patients at an urban safety-net hospital: a randomized clinical trial. Journal of American Medical Association Internal Medicine 2017;177(12):1798-807. - PMC - PubMed
    1. Lasser KE, Quintiliani LM, Truong V, Xuan Z, Pbert L. Patient navigation to promote smoking cessation in primary care: preliminary findings from an ongoing randomized controlled trial. Journal of General Internal Medicine 2017;32:266.
    1. Quintiliani LM, Russinova ZL, Bloch PP, Truong V, Xuan Z, Pbert L, et al. Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: a randomized controlled trial protocol. Contemporary Clinical Trials 2015;45(Part B):449-57. [PMID: ] - PubMed
Lee 2016 {published data only}
    1. Lee JE, Shin DW, Suh B, Chun S, Nam Y-S, Cho B. Development and application of culturally appropriate decision aids for smoking cessation in Korea: a pragmatic clustered randomization crossover trial. Patient Preference and Adherence 2016;10:1929-36. [DOI: 10.2147/ppa.s114387] - DOI - PMC - PubMed
Lennox 1998 {published data only}
    1. Lennox AS, Bain N, Taylor RJ, McKie L, Donnan PT, Groves J. Stages of change training for opportunistic smoking intervention by the primary health care team. Part 1: randomized controlled trial of the effect of training on patient smoking outcomes and health professional behaviour as recalled by patients. Health Education Journal 1998;57(2):140. [DOI: 10.1177/001789699805700206] - DOI
Lennox 2001 {published data only}
    1. Lennox AS, Osman LM, Reiter E, Robertson R, Friend J, McCann I, et al. Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial. BMJ 2001;322(7299):1396. [DOI: ] - PMC - PubMed
Leppänen 2019 {published data only}ISRCTN11498135
    1. Leppänen A, Ekblad S, Tomson. Tobacco Cessation on Prescription as a primary health care intervention targeting a context with socioeconomically disadvantaged groups in Sweden: a qualitative study of perceived implementation barriers and facilitators among providers. PLOS One 2019;14(2):e0212641. [DOI: 10.1371/journal.pone.0212641] - DOI - PMC - PubMed
    1. Leppänen A, Lindgren P, Sundberg CJ. A cluster-randomized controlled trial evaluating the effectiveness and cost-effectiveness of tobacco cessation on prescription in Swedish primary health care: a protocol of the Motivation 2 Quit (M2Q) Study. JMIR Research Protocols 2016;5(3):e188. - PMC - PubMed
    1. Leppänen A. Tobacco Cessation on Prescription: A Primary Healthcare Intervention Targeting Socioeconomically Disadvantaged Areas in Stockholm [thesis]. Stockholm: Karolinska Institutet, 2019. [ISBN 978-91-7831-567-3]
Lindsay 1989 {published data only}
    1. Lindsay EA, Wilson DM, Best JA, Willms DG, Singer J, Gilbert JR, et al. A randomized trial of physician training for smoking cessation. American Journal of Health Promotion 1989;3(3):11-8. [PMID: ] - PubMed
    1. Wilson DM, Lindsay EA, Best JA, Gilbert JR, Willms DG, Singer J. A smoking cessation intervention program for family physicians. Canadian Medical Association Journal 1987;137(7):613-9. [PMID: ] - PMC - PubMed
    1. Wilson DM, Taylor W Gilbert JR, Best A, Lindsay EA, Willms DG, et al. A randomized trial of family physician training for smoking cessation. JAMA 1988;260(11):1570-4. [PMID: ] - PubMed
Lou 2013 {published data only}
    1. Lou P, Chen P, Zhang P, Yu J, Wang Y, Chen N, et al. A COPD health management program in a community-based primary care setting: a randomized controlled trial. Respiratory Care 2015;60(1):102-12. [PMID: ] - PubMed
    1. Lou P, Zhu Y, Chen P, Zhang P, Yu J, Zhang N, et al. Supporting smoking cessation in chronic obstructive pulmonary disease with behavioral intervention: a randomized controlled trial. BMC Family Practice 2013;14:91. [DOI: 10.1186/1471-2296-14-91] - DOI - PMC - PubMed
Marley 2014 {published data only}
    1. Marley JV, Atkinson D, Kitaura T, Nelson C, Gray D, Metcalf S, et al. The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting. BMC Public Health 2014;14:32. [DOI: 10.1186/1471-2458-14-32] - DOI - PMC - PubMed
    1. Marley JV, Atkinson D, Nelson C, Kitaura T, Gray D, Metcalf S, et al. The protocol for the Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2012;12:232. [PMID: ] - PMC - PubMed
Mejia 2015 {published data only}
    1. Mejia R, Kaplan CP, Alderete M, Pena L, Gregorich S, Schoj V, et al. Effectiveness of an intervention to teach physicians in a middle-income country how to help their patients quit smoking. Journal of General Internal Medicine 2013;28(Suppl):S69.
    1. Mejia R, Perez Stable EJ, Kaplan CP, Gregorich SE, Livaudais-Toman J, Pena L, et al. Effectiveness of an intervention to teach physicians how to assist patients to quit smoking in Argentina. Nicotine and Tobacco Research 2015;18(5):1101-9. [DOI: 10.1093/ntr/ntv153] - DOI - PMC - PubMed
Meyer 2008 {published data only}
    1. Haug S, Meyer C, Ulbricht S, Schorr G, Ruge J, Rumpf HJ, et al. Predictors and moderators of outcome in different brief interventions for smoking cessation in general medical practice. Patient Education and Counseling 2010;78(1):57-64. [PMID: ] - PubMed
    1. Klein G, Ulbricht S, Haug S, Gross B, Rumpf HJ, John U, et al. Effects of practitioner-delivered brief counseling and computer-generated tailored letters on cigarettes per day among smokers who do not quit - a quasi-randomized controlled trial. Drug and Alcohol Dependence 2010;112(1-2):81-9. [PMID: ] - PubMed
    1. Meyer C, Ulbricht S, Baumeister SE, Schumann A, Rüge J, Bischof G, et al. Proactive interventions for smoking cessation in general medical practice: a quasi-randomized controlled trial to examine the efficacy of computer-tailored letters and physician-delivered brief advice. Addiction 2008;103(2):294-304. [DOI: 10.1111/j.1360-0443.2007.02031.x] - DOI - PMC - PubMed
    1. Meyer C, Ulbricht S, Schumann A, Hannover W, Hapke U, Rumpf H-J, et al. Inteventions fostering the motivation to quit for smokers in general practice. Suchtmedizin in Forschung und Praxis 2003;5(2):134-6.
    1. Ulrich John U, Ulbricht S, Goeze C, Meyer C. Brief intervention to motivate smokers to quit in primary medical care. European Journal of Cardiovascular Prevention and Rehabilitation 2011;18(1 Suppl 1):S40.
Meyer 2012 {published data only}
    1. Meyer C, Ulbricht S, Gross B, Kästel L, Wittrien S, Klein G, et al. Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: a three-arm cluster randomized trial. Drug and Alcohol Dependence 2012;121(1-2):124-32. [DOI: 10.1016/j.drugalcdep.2011.08.019] - DOI - PubMed
Minué‐Lorenzo 2019 {published data only}
    1. Minué-Lorenzo C, Olano-Espinosa E, Cura-González I, Vizcaíno-Sánchez JM, Camerelles-Guillem F, Granados-Garrido JA, et al. Subsidized pharmacological treatment for smoking cessation by the Spanish public health system: a randomized, pragmatic, clinical trial by clusters. Tobacco Induced Diseases 2019;17:64. - PMC - PubMed
Morgan 1996 {published data only}
    1. Morgan GD, Noll EL, Orleans CT, Rimer BK, Amfoh K, Bonney G. Reaching midlife and older smokers: tailored interventions for routine medical care. Preventative Medicine 1996;25(3):346-54. [DOI: 10.1006/pmed.1996.0065] - DOI - PubMed
Murray 2008 {published data only}
    1. Murray RL, Coleman T, Antoniak M, Fergus A, Britton J, Lewis SA. Promoting smoking cessation in primary care: a cluster-randomised controlled intervention trial of pro-actively identifying smokers and offering evidence-based support to stop smoking. American Journal of Respiratory and Critical Care Medicine 2007;175:A600.
    1. Murray RL, Coleman T, Antoniak M, Stocks J, Fergus A, Britton J, et al. The effect of proactively identifying smokers and offering smoking cessation support in primary care populations: a cluster-randomized trial. Addiction 2008;103(6):998-1006. [DOI: 10.1111/j.1360-0443.2008.02206.x] - DOI - PubMed
Nebot 1992 {published data only}
    1. Nebot M, Cabezas C, Oller M, Moreno F, Rodrigo J, Sarda T, et al. Medical counseling, nursing counseling, and nicotine chewing gum for smoking cessation in primary care [Consejo medico, consejo de enfermeria y chicle de nicotina para dejar de fumar en atencion primaria]. Medicina Clinica 1990;95(2):57-61. - PubMed
    1. Nebot M, Cabezas C. Does nurse counseling or offer of nicotine gum improve the effectiveness of physician smoking-cessation advice? Family Practice Research Journal 1992;12(3):263-70. - PubMed
Nichols 2017 {published data only}
    1. Hopkins RJ, Nichols JA, Grob P, Kite W, Williams P, Young RP. Gene-based risk test of lung cancer risk shows a dose-response effect in smoking cessation programme in the Surrey primary care study. American Journal of Respiratory and Critical Care Medicine 2014;189(Suppl):A1084.
    1. Nichols JA, Grob P, Lusignan S, Kite W, Williams P. Genetic test to stop smoking (GeTSS) trial protocol: randomised controlled trial of a genetic test (Respiragene) and Auckland formula to assess lung cancer risk. BMC Pulmonary Medicine 2014;14:77. - PMC - PubMed
    1. Nichols JAA, Grob P, Kite W, Williams P, Lusigan S. Using a genetic/clinical risk score to stop smoking (GeTSS): randomised controlled trial. BMC Research Notes 2017;10(507):1-9. [DOI: 10.1186/s13104-017-2831-2] - DOI - PMC - PubMed
Ockene 1994 {published data only}
    1. Ockene JK, Kristeller J, Goldberg R, Amick TL, Pekow PS, Hosmer D, et al. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial. Journal of General Internal Medicine 1991;6(1):1-8. [PMID: ] - PubMed
    1. Ockene JK, Kristeller J, Pbert L, Hebert JR, Luippold R, Goldberg RJ, et al. The physician-delivered smoking intervention project: can short-term interventions produce long-term effects for a general outpatient population? Health Psychology 1994;13(3):278-81. [DOI: 10.1037//0278-6133.13.3.278] - DOI - PubMed
Olano Espinosa 2013 {published data only}
    1. Olano-Espinosa E, Matilla-Pardo B, Minué C, Antón E, Gómez-Gascón T, Ayesta FJ. Effectiveness of a health professional training program for treatment of tobacco addiction.. Nicotine and Tobacco Research 2013;15(10):1682-9. [DOI: 10.1093/ntr/ntt040] - DOI - PubMed
Papadakis 2018 {published data only}
    1. Papadakis S, Cole AG, Reid RD, Assi R, Gharib M, Tulloch HE, et al. From good to great: the role of performance coaching in enhancing tobacco-dependence treatment rates. Annals of Family Medicine 2018;16(6):498-506. [PMID: ] - PMC - PubMed
    1. Papadakis S, Pipe AL, Reid RD, Tulloch H, Mullen KA, Assi R, et al. Effectiveness of performance coaching for enhancing rates of smoking cessation treatment delivery by primary care providers: study protocol for a cluster randomized controlled trial. Contemporary Clinical Trials 2015;45(Pt B):184-90. - PubMed
    1. Papadakis S, Reid RD, Cole AG, Assi R, Tulloch H, Gharib M, et al. Effectiveness of two multi-component interventions to increase tobacco dependence treatment rates in primary care: a cluster randomized controlled trial (as supplied 4 May 2017). Data on file.
Parkes 2008 {published data only}
    1. Parkes G, Greenhalgh T, Griffin, M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008;336(7644):598-600. [DOI: 10.1136/bmj.39503.582396.25] - DOI - PMC - PubMed
Pereira 2006 {published data only}
    1. Pereira BC, Stoebner-Delbarre A. A cluster randomised controlled trial of a continuing education programme - smoking cessation intervention. European Journal of Epidemiology 2006;21(Supplement 1):99. [DOI: 10.1007/s10654-006-9021-1] - DOI
    1. Stoebner-Delbarre A, Pereira B, Slama K, Gourgou S, Rijnoveanu A, Pujol H, et al. A cluster randomised controlled trial of a continuing education programme to increase general practitioner provision of smoking cessation interventions (as supplied 22 October 2015). Data on file.
Pérez Tortosa 2015 {published data only}
    1. Pérez-Tortosa S, Roig L, Manresa JM, Martin-Cantera C, Puigdomènech E, Roura P, et al. Continued smoking abstinence in diabetic patients in primary care: a cluster randomized controlled multicenter study. Diabetes Research and Clinical Practice 2015;107(1):94-103. [DOI: 10.1016/j.diabres.2014.09.009] - DOI - PubMed
    1. Roig L, Perez S, Prieto G, Martin C, Advani M, Armengol A, et al. Cluster randomized trial in smoking cessation with intensive advice in diabetic patients in primary care. ITADI Study. BMC Public Health 2010;10:58. - PMC - PubMed
Piper 2016 {published data only}
    1. Piper ME, Cook JW, Schlam TR, Smith SS, Bolt DM, Collins LM, et al. Toward precision smoking cessation treatment I: Moderator results from a factorial experiment. Drug and Alcohol Dependence 2017;171:59-65. [DOI: 10.1016/j.drugalcdep.2016.11.027] - DOI - PMC - PubMed
    1. Piper ME , Cook JW , Schlam TR , Smith SS , Bolt DM , Collins LM, et al. Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action. Drug and Alcohol Dependence 2017;171:50-8. [DOI: 10.1016/j.drugalcdep.2016.11.027] - DOI - PMC - PubMed
    1. Piper ME, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, et al. Identifying effective intervention components for smoking cessation: a factorial screening experiment. Addiction 2016;111(1):129-41. [DOI: 10.1111/add.13162] - DOI - PMC - PubMed
Piper 2018 {published data only}
    1. Piper ME, Cook JW, Schlam TR, Jorenby DE, Smith SS, Collins LM, et al. A randomized controlled trial of an optimized smoking treatment delivered in primary care. Annals of Behavioral Medicine 2018;52(10):854-64. [PMID: ] - PMC - PubMed
Pisinger 2010 {published data only}
    1. Pisinger C, Jørgensen MM, Møller NE, Døssing M, Jørgensen T. A cluster randomized trial in general practice with referral to a group-based or an Internet-based smoking cessation programme. Journal of Public Health 2010;32(1):62-70. [DOI: 10.1093/pubmed/fdp072] - DOI - PubMed
Ramos 2010 {published data only}
    1. Montserrat MR. Effectiveness of advanced group and individual interventions in tackling tobacco dependency in primary care [Efectividad de las intervenciones grupal e individual avanzadas para el abordaje del tabaquismo.]. Atencion Primaria 2005;36(8):462-5. [PMID: ] - PMC - PubMed
    1. Ramos M, Ripoll J, Estrades T, Socias I, Fe A, Duro R, et al. Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial. BMC Public Health 2010;10:89. [DOI: 10.1186/1471-2458-10-89] - DOI - PMC - PubMed
RBR‐7yx9hd {published data only}
    1. RBR-7yx9hd. Cost-effectiveness evaluation between two approaches to treatment of smoking in the SUS (Unified Health System): brief intervention and intensive approach to the smoker [Avaliação de Custoefetividade entre duas abordagens para o tratamento do Tabagismo no SUS: Intervenção Breve e abordagem intensiva do fumante]. www.ensaiosclinicos.gov.br/rg/RBR-7yx9hd/ (first received 6 January 2015).
Richmond 1993 {published data only}
    1. Richmond RL, Kehoe LA, Webster IW. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction 1993;88(8):1127-35. [PMID: ] - PubMed
    1. Richmond RL, Makinson RJ, Kehoe LA, Giugni AA, Webster IW. One-year evaluation of three smoking cessation interventions administered by general practitioners. Addictive Behaviors 1993;18(2):187-99. [DOI: 10.1016/0306-4603(93)90049-f] - DOI - PubMed
Ronaldson 2018 {published data only}
    1. Ronaldson SJ, Dyson L, Clark L, Hewitt CE, Torgerson DJ, Cooper BG, et al. The impact of lung function case-finding tests on smoking behaviour: a nested randomised trial within a case-finding cohort. Health Science Reports 2018;1(6):e41. - PMC - PubMed
Roski 2003 {published data only}
    1. Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, et al. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Preventive Medicine 2003;36(3):291-9. [DOI: 10.1016/s0091-7435(02)00052-x] - DOI - PubMed
Russell 1983 {published data only}
    1. Russell MA, Merriman R, Stapleton J, Taylor W. Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. British Meical Journal (Clinical Research Edition) 1983;287(6407):1782-5. [DOI: 10.1136/bmj.287.6407.1782] - DOI - PMC - PubMed
Salkeld 1997 {published data only}
    1. Salkeld G, Phongsavan P, Oldenburg B, Johannesson M, Convery P, Graham-Clarke P, et al. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Health Policy 1997;41(2):105-19. [PMID: ] - PubMed
Sanz‐Pozo 2006 {published data only}
    1. Sanz-Pozo B, Miguel-Diaz J, Aragon-Blanco M, Garcia-Caballo M, Gomez-Suarez E, Fernandez-Dominguez JF. Effectiveness of a programme of intensive tobacco counselling by nursing professionals [Efectividad de un programa de consejo antitabaco intensivo realizado por profesionales de enfermería]. Atencion Primaria 2006;37:266-72. - PMC - PubMed
    1. Sanz Pozo B, Miguel Diaz J, Aragon Blanco M, Gonzalez Gonzalez AI, Cortes Catalan M, Vazquez I. Effectiveness of non-pharmacological primary care methods for giving up tobacco dependency [Efectividad de los métodos no farmacológicos para la deshabituación tabáquica en atención primaria]. Atencion Primaria 2003;32(6):366-70. - PMC - PubMed
Secades Villa 2009 {published data only}
    1. Alonso-Perez F, Secades-Villa R, Duarte Climent G. Are psychological treatments effective to stop smoking? [?Son eficientes los tratamientos psicologicos para dejar de fumar?]. Trastornos Adictivos 2007;9(1):21-30.
    1. Secades-Villa R, Alonso-Pérez F, García-Rodríguez O, Fernández-Hermida JR. Effectiveness of three intensities of smoking cessation treatment in primary care. Psychological Reports 2009;105(3 Part 1):747-58. [DOI: 10.2466/PR0.105.3.747-758] - DOI - PubMed
Segnan 1991 {published data only}
    1. Segnan N, Ponti A, Battista RN, Senore C, Rosso S, Shapiro SH, et al. A randomized trial of smoking cessation interventions in general practice in Italy. Cancer Causes and Control 1991;2(4):239-46. [DOI: 10.1007/BF00052140] - DOI - PubMed
Sherman 2007 {published data only}
    1. Sherman SE, Estrada M, Lanto AB, Farmer MM, Aldana I. Effectiveness of an on-call counselor at increasing smoking treatment. Journal of General Internal Medicine 2007;22(8):1125-31. [DOI: 10.1007/s11606-007-0232-2] - DOI - PMC - PubMed
Sherman 2008 {published data only}
    1. Sherman SE, Takahashi N, Kalra P, Gifford E, Finney JW, Canfield J, et al. Care coordination to increase referrals to smoking cessation telephone counseling: a demonstration project. American Journal of Managed Care 2008;14(3):141-8. [PMID: ] - PubMed
Siddiqi 2013 {published data only}
    1. Dogar O, Jawad M, Shah SK, Newell JN, Kanaan M, Khan MA, et al. Effect of cessation interventions on hookah smoking: post-hoc analysis of a cluster-randomized controlled trial. Nicotine and Tobacco Research 2014;16(6):682-8. - PubMed
    1. Siddiqi K, Khan A, Ahmad M, Dogar O, Kanaan M, Newell JN, et al. Action to stop smoking in suspected tuberculosis (ASSIST) in Pakistan: a cluster randomized, controlled trial. Annals of Internal Medicine 2013;158(9):667-75. [DOI: 10.7326/0003-4819-158-9-201305070-00006] - DOI - PubMed
    1. Siddiqi K, Khan A, Ahmand M, Rehman SU. An intervention to stop smoking among patients suspected of TB - evaluation of an integrated approach. BMC Public Health 2010;10:160. - PMC - PubMed
Sippel 1999 {published data only}
    1. Sippel JM, Osborne ML, Bjornson W, Goldberg B, Buist AS. Smoking cessation in primary care clinics. Journal of General Internal Medicine 1999;14(11):670-6. [DOI: 10.1046/j.1525-1497.1999.11088.x] - DOI - PMC - PubMed
Swartz 2006 {published data only}
    1. Swartz S, Cowan T, DePue J, Mooney-Murray K, Haskins AE, Leighton AR, et al. Academic detailing and data feedback to increase tobacco treatment in primary care: a randomized trial (as supplied 21 October 2015). Data on file.
    1. Swartz S, Cowan T. A randomized trial of academic profiling increases provider tobacco intervention. Nicotine and Tobacco Research 2006;9(1 Supplement 2):S135. [DOI: 10.1080/14622200601038651] - DOI
Twardella 2007 {published data only}
    1. Brenner H, Twardella D. Best practice for smoking cessation in general practices - a RCT. Suchtkongress 2008;54(4):250-4.
    1. Brenner H, Twardella D. Giving up smoking with a general practitioner - results of a cluster-randomised study [Raucherentwohnung beim Hausarzt - Ergebnisse einer Cluster-randominisierten Studie]. Sucht 2006;52(1):63.
    1. Salize HJ, Merkel S, Reinhard I, Twardella D, Mann K, Brenner H. Cost-effective primary care-based strategies to improve smoking cessation: more value for money. Archives of Internal Medicine 2009;169(3):230-5. [PMID: ] - PubMed
    1. Salize HJ, Reinhard I, Mann K, Twardella D, Brenner H. Cost-effectiveness of smoking cessation treatment in primary care. Suchtkongress 2008;54(4):250-4.
    1. Twardella D, Brenner H. Effects of practitioner education, practitioner payment and reimbursement of patients' drug costs on smoking cessation in primary care: a cluster randomised trial. Tobacco Control 2007;16(1):15-21. [DOI: 10.1136/tc.2006.016253] - DOI - PMC - PubMed
Unrod 2007 {published data only}
    1. Smith MY, Cromwell J, DePue J, Spring B, Redd W, Unrod M. Determining the cost-effectiveness of a computer-based smoking cessation intervention in primary care. Managed Care 2007;16(7):48-55. - PubMed
    1. Unrod M, Smith M, Spring B, DePue J, Redd W, Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. Journal of General Internal Medicine 2007;22(4):478-84. - PMC - PubMed
Van Rossem 2017 {published data only}
    1. Van Rossem C, Spigt M, Smit ES, Viechtbauer W, Mijnheer KK, Schayck CP, et al. Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: study protocol of a pragmatic randomized controlled trial. Contemporary Clinical Trials 2015;41:298-312. [PMID: 25657051] - PubMed
    1. Rossem C, Spigt M, Viechtbauer W, Lucas AEM, Schayck OCP, Kotz D. Effectiveness of intensive practice nurse counselling versus brief general practitioner advice, both combined with varenicline, for smoking cessation: a randomized pragmatic trial in primary care. Addiction 2017;112(12):2237-47. [DOI: 10.1111/add.13927] - DOI - PubMed
Verbiest 2014 {published data only}
    1. Verbiest ME, Crone MR, Scharloo M, Chavannes NH, Van der Meer V, Kaptein AA, et al. One-hour training for general practitioners in reducing the implementation gap of smoking cessation care: a cluster-randomized controlled trial. Nicotine and Tobacco Research 2014;16(1):1-10. [DOI: 10.1093/ntr/ntt100] - DOI - PubMed
    1. Verbiest ME, Presseau J, Chavannes NH, Scharloo M, Kaptein AA, Assendelft WJ, et al. Use of action planning to increase provision of smoking cessation care by general practitioners: role of plan specificity and enactment. Implementation Science 2014;9:180. [PMID: ] - PMC - PubMed
Vetter 1990 {published data only}
    1. Vetter NJ, Ford D. Smoking prevention among people aged 60 and over: a randomized controlled trial. Age and Ageing 1990;19(3):164-8. - PubMed
Yano 2008 {published data only}
    1. Yano EM, Rubenstein LV, Farmer MM, Chernof BA, Mittman BS, Lanto AB, et al. Targeting primary care referrals to smoking cessation clinics does not improve quit rates: Implementing evidence-based interventions into practice. Health Research and Educational Trust 2008;43(5):1637-61. [DOI: 10.1111/j.1475-6773.2008.00865.x] - DOI - PMC - PubMed
Young 2008 {published data only}
    1. Young JM, Girgis S, Bruce TA, Hobbs M, Ward JE. Acceptability and effectiveness of opportunistic referral of smokers to telephone cessation advice from a nurse: a randomised trial in Australian general practice. BMC Family Practice 2008;9:16. [DOI: 10.1186/1471-2296-9-16] - DOI - PMC - PubMed
Zwar 2015 {published data only}
    1. Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, et al. Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC Family Practice 2010;11:59. [PMID: ] - PMC - PubMed
    1. Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, et al. Supporting smoking cessation in primary care: results of the quit in general practice study. Respirology 2014;19:23.
    1. Zwar N, Richmond RL, Halcomb E, Furler J, Smith J, Hermiz O, et al. Supporting smoking cessation in Australian primary care: results of the quit in general practice study. Global Heart 2014;9(1 Supplement 1):e232.
    1. Zwar NA, Richmond RL, Halcomb EJ, Furler JS, Smith JP, Hermize O, et al. Quit in general practice: a cluster randomized trial of enhanced in-practice support for smoking cessationQuit in general practice: a cluster randomized trial of enhanced in-practice support for smoking cessation. Family Practice 2015;32(2):173-80. [DOI: 10.1093/fampra/cmu089] - DOI - PubMed

References to studies excluded from this review

Adair 2013 {published data only}
    1. Adair R, Wholey DR, Christianson J, White KM, Britt H, Lee S. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Annals of Internal Medicine 2013;159(3):176-84. - PubMed
Adam 2019 {published data only}
    1. Adam A, Schwartz RP, Wu LT, Subramaniam G, Laska E, Sharma G, et al. Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool. Addiction Science & Clinical Practice 2019;14(1):39. [DOI: 10.1186/s13722-019-0167-z] - DOI - PMC - PubMed
Agarwal 2018 {published data only}
    1. Agarwal SD, Kerwin M, Meindertsma J, Wolf AM. A novel decision aid to encourage smoking cessation among patients at an urban safety net clinic. Preventing Chronic Disease 2018;15:E124. [PMID: ] - PMC - PubMed
An 2008 {published data only}
    1. An LC, Bluhm JH, Foldes SS, Alesci NL, Klatt CM, Center BA , et al. A randomized trial of a pay-for-performance program targeting clinician referral to a state tobacco quitline. Archives of Internal Medicine 2008;168(18):1993-9. [DOI: 10.1001/archinte.168.18.1993] - DOI - PubMed
Andrews 2001 {published data only}
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Aveyard 2007 {published data only}
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Butler 1999 {published data only}
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Carey 2016 {published data only}
    1. ACTRN12616001443482. Testing the effectiveness of point-of-care touchscreen computer assessment and printed feedback for improving self-management of health risks among general practice patients. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12616001443482 (first submitted 29 September 2016).
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    1. Cheung NW, Redfern J, Thiagalingam A, Hng TM, Islam SM, Haider R, et al. Text messaging support for patients with diabetes or coronary artery disease (SupportMe): protocol for a pragmatic randomised controlled trial. BMJ Open 2019;9:e025923. [DOI: 10.1136/bmjopen-2018-025923] - DOI - PMC - PubMed
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    1. Drexel C, Jacobson A, Hanania NA, Whitfield B, Katz J, Sullivan T. Measuring the impact of a live, case-based, multiformat, interactive continuing medical education program on improving clinician knowledge and competency in evidence-based COPD care. International Journal of Chronic Obstructive Pulmonary Disease 2011;6:297-307. [PMID: ] - PMC - PubMed
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    1. Felton WL, Kornstein SG, Huynh C, Masho SW, Gondwe T, Wallenborn JT. A stroke and cardiovascular disease risk alert in the electronic health record increased prescriptions for smoking cessation in women. Stroke 2019;50(Suppl 1):WP377. [DOI: 10.1161/str.50.suppl_1.WP377] - DOI
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    1. Fulton E, Newby K, Gokal K, Kwah K, Schumacher L, Jackson LJ, et al. Tailored digital behaviour change intervention with e-referral system to increase attendance at NHS stop smoking services (the MyWay project): study protocol for a randomised controlled feasibility trial. BMJ Open 2019;9:e028721. [DOI: 10.1136/bmjopen-2018-028721] - DOI - PMC - PubMed
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    1. Gilbody S, Peckham E, Bailey D, Arundel C, Heron P, Crosland S, et al. Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. Lancet Psychiatry 2019;6(5):379-90. [DOI: 10.1016/S2215-0366(19)30047-1] - DOI - PMC - PubMed
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    1. Godycki-Cwirko M, Zakowska I, Kosiek K, Wensing M, Krawczyk J, Kowalczyk A. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial. Trials 2014;15:109. - PMC - PubMed
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    1. Jennings C, Kotseva K, De Bacquer D, Hoes A, De Velasco J, Brusaferro S, et al. Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial. European Heart Journal 2014;35(21):1411-20. [DOI: 10.1093/eurheartj/ehu051] - DOI - PubMed
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Kalkhoran 2016 {published data only}
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