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

摘要

Abstract Aims To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6?months’ tobacco abstinence (primary outcome). Secondary outcomes included 12‐month abstinence, medication adherence and incremental costs per life‐year gained. Design A multi‐site ( n ?=?10), two‐group, parallel, pragmatic randomized controlled trial. Setting A network of primary health‐care centres in the Netherlands. Participants A total of 295 adult daily smokers (mean age?=?48?years; mean cigarettes/day?=?19). Intervention and comparator Patients were randomized to receive individual counselling by a practice nurse (PN) ( n ?=?149) or brief advice by a general practitioner (GP) (146). All patients received 12?weeks of open‐label varenicline. Measurements The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (?80%?days taken) and incremental costs per life‐year gained. Findings Abstinence rates in the PN versus GP groups were 32.2% ( n ?=?48) versus 39.0% [ n ?=?57; odds ratio (OR)?=?0.71; 95% confidence interval (CI)?=?0.44–1.16] from weeks 9 to 26 and 25.5% ( n ?=?38) versus 28.8% ( n ?=?42; OR?=?0.84, 95% CI?=?0.50–1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n ?=?56/123) than in the GP group (62.0%, n ?=?75/121; OR?=?0.45, 95% CI?=?0.26–0.77), and the incremental costs per life‐year gained were –?416.10. Conclusions Among people seeking help to stop smoking from their general practice, one‐off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided.