Family Practice Advance Access originally published online on August 9, 2008
Family Practice 2008 25(5):382-389; doi:10.1093/fampra/cmn046
In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial
a VicHealth Centre for Tobacco Control, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC, Australia
b Program Evaluation Unit, School of Population Health, University of Melbourne, Melbourne, Australia
c School of Primary Health Care, Faculty of Medicine and Health Sciences, Monash University, Melbourne, Australia
d Department of General Practice, Monash University, Melbourne, Australia
Correspondence to Ron Borland, VicHealth Centre for Tobacco Control, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC, Australia; Email: ron.borland{at}cancervic.org.au
Received 11 November 2007; Revised 4 June 2008; Accepted 8 July 2008.
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Abstract |
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Background and objective. GPs are an important source of smoking cessation advice. This research examined whether a model encouraging GP referral of patients who smoke to a specialist service would be acceptable and effective for increased smoking cessation when compared with a model of in-practice management.
Methods. The study design was cluster randomized controlled trial. Practices were randomized to one of two interventions, at a rate of 1:2: (i) standard in-practice GP management or (ii) referral to a quitline service. The main outcome measures were sustained abstinence of 
1 month duration at 3-month follow-up and 10 months duration at 12 months, using intention to treat analysis.
Results. At 3-month follow-up, patients in the referral condition were twice as likely to report sustained abstinence than those in the in-practice condition [12.3% compared with 6.9%; odds ratio (OR) = 1.92 (95% confidence interval (CI) 1.17–3.13]. At 12-month follow-up, patients in the referral condition had nearly three times the odds of sustained abstinence [6.5% compared with 2.6%; OR = 2.86 (95% CI 0.94–8.71)]. The intervention effect was mediated by the amount of help received outside the practice.
Conclusions. This research provided evidence that GPs referring smokers to an evidence-based quitline service results in increased cessation. The benefit is largely due to patients in the referral condition receiving more external help than patients in the in-practice condition, as they received equivalent practice-based help. Where suitable services exist, we recommend that referral become the normative strategy for management of smoking cessation in general practice to complement any practice-based help provided.
Keywords. Cluster randomized controlled trial, GPs, primary care, referral, smoking cessation.
Borland R, Balmford J, Bishop N, Segan C, Piterman L, McKay-Brown L, Kirby C and Tasker C. In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial.Family Practice 2008; 25: 382–389.