A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients

Abstract

BackgroundTobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population.ObjectiveThe objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic.Trial designCluster randomised controlled trial.MethodsAll patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation.ResultsOf 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20).ConclusionsIt would be feasible to definitively evaluate this intervention in a large multi-site trial.Trial registration numberhttp://ClinicalTrials.gov # UOHI2010-1.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…Tobacco dependence is a chronic condition for which there are effective behavioral and pharmacotherapy treatments. [317][318][319][320][321][322] Updated information on how to treat tobacco dependence is available in Treating Tobacco Use and Dependence: 2008 Update. …”

The clinical significance and reliability of self-reported smoking status in patients with intracranial aneurysms: A review

“…Despite the fact that a relationship between smoking and subarachnoid hemorrhage has been firmly established, no studies have yet evaluated smoking cessation rates around the time of diagnosis of intracranial aneurysm, either ruptured or unruptured, using objective metrics of smoking cessation. This is in contrast to the situation with smoking and ischemic stroke, in which smoking cessation rates have been reported in a number of studies [7][8][9]. While smokers make up a higher percentage of patients with ruptured aneurysms than unruptured aneurysms, the benefit of smoking cessation on patients with already diagnosed intracranial aneurysms has not yet been established.…”

Increasing Rates of Tobacco Treatment Delivery in Primary Care Practice: Evaluation of the Ottawa Model for Smoking Cessation

“…The effect sizes documented in this evaluation are consistent with rates observed in our earlier randomized trial evaluation of the OMSC program. 13,14 The present evaluation was not a randomized controlled trial but rather focused on the broader implementation of an evidence-based intervention in "real-world settings." The large sample allowed us to test the generalizability of the OMSC program.…”

“…6,7 We previously demonstrated the efficacy of the OMSC as part of a pilot study involving 8 primary care practices; that study, a randomized, controlled trial, demonstrated significant improvements in tobacco treatment delivery. 13,14 The efficacy of interventions can be quite different, however, in day-to-day clinical practice. The importance of translating knowledge of and evaluating evidence-based practices in 'real world' practice settings has been widely acknowledged.…”