Over the past 20 years, the provision of smoking cessation intervention in primary
care has been on the rise. While early reports in late 1980's and 90's have documented
that less than 50% of smokers were ever advised to quit (Anda et al., 1987, Goldstein
et al., 1997), more recent surveys of both smokers and physicians have revealed that
close to 90% of patients are asked of their smoking status and now more than three
quarters are advised to quit (AAMC, 2007, King et al., 2013). Evaluating data from
the 2009–2010 United States National Adult Tobacco Survey, King et al. recently documented
strong provider compliance with the ask and advise components of the 5A's model of
physician smoking cessation practice guidelines (Fiore et al., 2008); however, moderate
to weak compliance with the assessment, assist and arrangement of follow-up components
(King et al., 2013). Of particular note, the study also found that 78.2% of all smokers
were offered any assistance and approximately half (49.5%) were provided with 2 or
more forms of assistance in the past 12 months, consisting of brief intervention (e.g.
booklets, websites), cessation program referral, or medication prescription. Our results
from a Canadian population survey conducted in the context of an ongoing trial (study
protocol — Cunningham et al., 2011), similarly indicate that 43.3% of adult regular
smokers with an intent to quit in the next 6 months (n = 1242) had received brief
intervention and nicotine replacement therapy (NRT) or medication, and only 15% had
reported receiving both counseling and NRT or medication.
While these rates indicate that the provision of some assistance is now more commonplace,
offers of combined or alternate lines of support following a failed quit attempt are
far from the norm. More importantly however, the above rates are only reflective of
smokers being provided with two or more forms of intervention sometime in the past
year and do not necessarily speak to the best practice guideline of combined provision
of behavioral and pharmacotherapeutic interventions (Fiore et al., 2008, Hurt et al.,
1994). In fact, no population or physician surveys to date have reported on the concurrent
provision of several smoking cessation interventions. As such, it is striking that
population level prevalence rates on the provision of the most effective form of primary
care cessation support are simply unknown.
Identifying physician compliance with best practice guidelines is necessary and certainly
highly encouraged for future population surveys. While the number of received interventions
may be telling of physician resourcefulness and persistence in tailoring a treatment
plan, the concurrent provision of interventions would be more indicative of physician
training and implementation of evidence-based interventions. Documenting the concurrent
provision of cessation interventions in particular, is not only important for current
indices of physician practices but also for evaluating effectiveness of recent system-wide
changes to the provision of tobacco-related interventions in primary care (Kunyk et
al., 2014, Land et al., 2012). As more jurisdictions adopt the integrated, multicomponent
systems pathway to tobacco treatment, a comprehensive assessment of the types, frequency,
duration, as well as combined provision of smoking cessation assistance can help provide
a deeper understanding of the gaps and barriers in effective delivery of cessation
interventions.
Conflicts of interest statement
The authors have no conflicts of interest to declare. This research was funded by
the Canadian Institutes for Health Research (CIHR) grant 111029. The funding organization
did not have a role in the design and conduct of the study; collection, management,
analysis, and interpretation of the data; preparation, review, or approval of the
manuscript; and decision to submit the manuscript for publication.
Financial disclosure
No financial disclosures were reported by the authors of this paper.