Are Nurses and Auxiliary Healthcare Workers Equally Effective in Delivering Smoking Cessation Support in Primary Care?

Abstract

Introduction:Smoking cessation support is increasingly delivered in primary care by auxiliary healthcare workers in place of healthcare professionals. However, it is unknown whether this shift might affect the quality and impact of the support delivered.Methods:Data from the iQuit in Practice randomized control trial of cessation support in General Practice was used (N = 602). Analyses assessed whether cessation advisor type (nurse or healthcare assistant [HCA]) was associated with abstinence (primary outcome: self-reported 2-week point prevalence abstinence at 8 weeks follow-up), the advice delivered during the initial consultation, pharmacotherapies prescribed, patient satisfaction, initial consultation length, and the number and type of interim contacts.Results:There were no statistically significant differences in abstinence for support delivered by HCAs versus nurses at 8 weeks (HCAs 42.8%, nurses 42.6%; unadjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.73 to 1.40), or at 4 weeks or 6 months follow-up. There were no statistically significant differences in advice delivered, the types of pharmacotherapies prescribed or patient satisfaction. Compared with nurses, HCA consultations were longer on average (HCAs 23.6 minutes, nurses 20.8 minutes; P = .002) and they undertook more interim contacts (HCAs median 2, nurses median 1; P < .001), with contact more likely to be face-to-face than phone call (HCAs 91.2%, nurses 70.9%; OR = 4.23, 95% CI = 2.86 to 6.26).Conclusions:HCAs appear equally effective as nurses in supporting smoking cessation, although they do this with greater patient contact. Using auxiliary practitioners to deliver cessation support could free up nurse time and reduce costs.Implications:This study found that primary care patients receiving smoking cessation support from auxiliary healthcare workers were just as likely to be abstinent up to 6 months later as those patients seen by nurses. While the auxiliary healthcare workers achieved this with slightly increased patient contact time, the advice delivered, pharmacotherapies provided and patient satisfaction were similar to that of nurses. Expanding the auxiliary healthcare worker role to include smoking cessation support could increase role satisfaction and reduce the costs of cessation support delivery in primary care.

Stopping smoking advice given by practice assistants after routine cervical screening in general practice: a qualitative exploration of potential barriers and enablers.

“…General practitioners (GPs) and nurses were also not sure whether assistants would be capable of providing this advice. This ambivalence to the provision of stopping smoking advice by practice assistants stands in contrast with results from studies showing that advice or counselling given by assistants is at least as effective as similar care provided by registered nurses (8)(9)(10). It also contrasts with the findings of qualitative studies conducted in the U. K. that report that GPs and nurses consider smoking cessation to be a suitable task for practice assistants (22,23).…”

“…In the Netherlands, the national cervical cancer screening programme is carried out in general practice and the smear is performed by a practice assistant, while stopping smoking advice or support is mainly delivered by general practitioners (GPs) and/or by qualified nurses. Although studies on the provision of stopping smoking care by auxiliary healthcare workers (such as practice assistants) are sparse, there is evidence that advice given by the practice assistant is as effective as interventions of doctors and nurses (8)(9)(10)(11)(12). As practice assistants are employed in most Dutch general practices, they could have a potential role in registering smoking status, giving stopping smoking advice, or referring patients on to cessation counselling.…”

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

“…Quality scores, as assessed by the ICROMS tool, varied between studies. Three studies were scored at the minimum threshold for their study design [ 51 , 57 , 60 ], three studies scored 1–2 points above threshold [ 52 , 53 , 65 ], and eleven studies exceeded the minimum cut-off score by 3 or more points [ 50 , 54 – 56 , 58 , 59 , 61 – 64 , 66 ].…”

Assessment of the Effectiveness and Cost-Effectiveness of Tailored Web- and Text-Based Smoking Cessation Support in Primary Care (iQuit in Practice II): Protocol for a Randomized Controlled Trial

“…Physicians, nurses, and other health care practitioners are in a prime position to engage with and provide smoking cessation support to patients presenting at specialized health clinics (eg, asthma, hypertension, diabetes) and general consultations. Many practices train at least one health care practitioner to offer and deliver smoking cessation support, and the two most commonly trained practitioners to deliver support (ie, health care assistants and nurses) are equally effective at delivering this support [ 8 ].…”