How To Support Smoking Cessation In Primary Care And The Community: A Systematic Review Of Interventions For The Prevention Of Cardiovascular Diseases
Received 3 July 2019
Accepted for publication 14 September 2019
Published 31 October 2019 Volume 2019:15 Pages 485—502
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Pietro Scicchitano
Michele Odorico,1 Delphine Le Goff,1 Naomi Aerts,2 Hilde Bastiaens,2 Jean Yves Le Reste1
1Department of General Practice, EA 7479 SPURBO, Université de Bretagne Occidentale (UBO – University of West Brittany), Brest, France; 2Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
Correspondence: Michele Odorico
Department of General Practice, EA 7479 SPURBO, Université de Bretagne Occidentale (UBO – University of West Brittany), 22 rue Camille Desmoulins, Brest 29238, France
Introduction: Smoking is a major risk factor for cardiovascular diseases (CVDs) and for many types of cancers. Despite recent policies, 1.1 billion people are active smokers and tobacco is the leading cause of mortality and illness throughout the world. The aim of this work was to identify smoking cessation interventions which could be implemented in primary care and/or at a community level.
Methods: A systematic review of CVDs prevention guidelines was realized using the ADAPTE Process. These were identified on G-I-N and TRIP databases. Additionally, a purposive search for national guidelines was successfully undertaken. Guidelines focusing on non-pharmacological lifestyle interventions, published or updated after 2011, were included. Exclusion criteria were specific populations, management of acute disease and exclusive focus on pharmacological or surgical interventions. After appraisal with the AGREE II tool, high-quality guidelines were included for analysis. High-grade recommendations and the supporting bibliographic references were extracted. References had to be checked in detail where sufficient information was not available in the guidelines.
Results: Nine hundred and ten guidelines were identified, 47 evaluated with AGREE II and 26 included. Guidelines recommended that patients quit smoking and that health care professionals provided advice to smokers but failed to propose precise implementation strategies for such recommendations. Only two guidelines provided specific recommendations. In the guideline bibliographic references, brief advice (BA) and multiple session strategies were identified as effective interventions. These interventions used Prochaska theory, motivational interviewing or cognitive-behavioral therapies. Self-help documentation alone was less effective than face-to-face counseling. Community-based or workplace public interventions alone did not seem effective.
Discussion: Behavioral change strategies were effective in helping patients to give up smoking. BA alone was less effective than multiple session strategies although it required fewer resources. Evidence for community-based interventions effectiveness was weak, mainly due to the lack of robust studies.
Keywords: cardiovascular diseases, primary prevention, smoking cessation, primary health care
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