Tratamiento grupal multicomponente para dejar de fumar en atención primaria. Resultados de 5 años de intervención en un centro de salud

[Multicomponent treatment of tobacco in primary care: Follow-up over 5years]

OBJECTIVES

To analyze the effectiveness of a multicomponent treatment for smoking cessation carried out in primary care and to evaluate the evolution of the consumption of tobacco that the people who participated had, more than 5 years after the end of the treatment.

DESIGN

Longitudinal study of 307 participants in a multicomponent program in group format of tobacco cessation.

EMPLACEMENT

Santander (Spain) Primary Care Health Center.

PARTICIPANTS

Smokers from the basic health zone who wanted to quit smoking between 2006 and 2012 and requested help.

INTERVENTIONS

Multicomponent treatment of 5face-to-face sessions and follow-up for up to 12 months.

PRIMARY MEASUREMENTS

The activity was evaluated in 263 participants more than 5years after the end of treatment. The results of continuous and punctual withdrawal were obtained by self-declaration and the data recorded in the medical record. The punctual was also validated with co-oximetry.

RESULTS

After a year 42.7% of participants declared continuous abstinence. From 5 to 12 years later, the continuous declared abstinence further than 12 months was 40.7%. They did not smoke again since the end of the treatment 66 people; 68.0% of those who relapsed made new attempts and 45.5% of them requested help to quit smoking.

CONCLUSIONS

The proposed multi-component treatment is effective. Abstinence at 12 months predicts long-term maintenance and participating in disabling groups favors further attempts in case of relapse and the request for help to quit smoking.

Effectiveness of individual and group multicomponent interventions for smoking cessation in primary care: a quasi-experimental study

BACKGROUND

The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice.

OBJECTIVE

To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices.

METHODS

A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients.

RESULTS

The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065-3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006-3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126-4.980, P < 0.05) were significantly associated with smoking cessation.

CONCLUSIONS

Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment.

[Smoking intervention in patients with cardiovascular diseases]

Smoking tobacco is the main cardiovascular risk factor and has a dose-dependent response. It has been shown that an aggressive policy, not only against consumption, achieves a significant decrease in cardiovascular deaths. Thus, we must provide and carry out activities to prevent or decrease the incidence of smoking (primary prevention), and to the early detection of the smoker and to reduce the prevalence (secondary prevention), and lastly to act on the effects of tobacco smoke, preventing complication and remissions (tertiary prevention). Thus, all health care levels must act in order that smokers do not develop cardiovascular disease when they quit smoking, both from Primary, as well as specialist care.