Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2013 Apr 5;27(9):629–636. [Article in Spanish] doi: 10.1016/S0212-6567(01)78871-3

Deshabituación tabáquica en una consulta de atención primaria: eficacia del consejo médico, la intervención mínima y la terapia sustitutiva con nicotina al año de seguimiento

Tobacco detoxication at a primary care clinic: efficacy of medical counselling, the minimal intervention and nicotine replacement therapy at the one-year control

M Torrecilla García a,*, M Barrueco Ferrero b, JA Maderuelo Fernández c, CA Jiménez Ruiz d, MD Plaza Martín a, MA Hernández Mezquita a
PMCID: PMC7688602  PMID: 11412554

Abstract

Objective

The main objective was to compare the efficacy of one-off tobacco counselling and of the systematic minimum intervention on making people give up smoking. A secondary aim was to evaluate the efficacy of nicotine replacement therapy (NRT) in the context of a primary care consultation.

Design

Controlled and randomised clinical trial.

Setting

Primary care.

Participants

Smokers who over 12 months attended a primary care clinic at an urban health centre (304 patients).

Interventions

Two kinds of intervention were conducted at random on patients with low nicotine dependence (one-off medical counselling and counselling integrated into what is known as the minimal intervention, but conducted systematically). NRT was administered through nicotine patches (11% nicotine) to patients with moderate-to-high nicotine dependence.

Measurements and main results

Short-term cessation a year after the minimal intervention was 39% (29.4-49.3%), and maintained cessation 30.9% (29.4-49.3%), as against 11% (5.6-18.8%) short-term cessation in the group that received one-off counselling (p < 0.0001). Short-term tobacco cessation in the NRT group was 35.3% (24.1-47.8%), and maintained cessation 30.8%.

Conclusions

Primary care is a suitable context for an intervention against tobacco dependency, through the use of any of the established interventions: one-off medical counselling, systematic minimal intervention, or specialist drug treatment through NRT. Therefore, these kinds of intervention must form part of PC clinics' daily activity.

Key words: Tobacco dependency, Smoking cessation, Primary care

Bibliografía

  • 1.Ministerio de Sanidad y Consumo; Madrid: 1999. Encuesta Nacional de Salud 1997. [Google Scholar]
  • 2.González J., Villar F., Banegas J.R., Rodríguez F., Martín J.M. Tendencia de la mortalidad atribuible al tabaquisno en España, 1978-1992: 600.000 muertes en 15 años. Med Clin (Barc) 1997;109:577–582. [PubMed] [Google Scholar]
  • 3.Russell M.A., Wilson C., Taylor C., Baker C.D. Effect of general practitioner's advice against smoking. BMJ. 1979;2:231–235. doi: 10.1136/bmj.2.6184.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Prochaska J.O., DiClemente C.C. Stages and proccesses of self change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–395. doi: 10.1037//0022-006x.51.3.390. [DOI] [PubMed] [Google Scholar]
  • 5.The Agency for Health Care Policy and Research Smoking cesation clinical practice guideline. JAMA. 1996;275:1270–1280. [PubMed] [Google Scholar]
  • 6.Silagy C., Ketteridge S. The Cochrane Library, Issue 4. Update Software; Oxford: 1988. Physician advice for smoking cessation (Cochrane Review) [Google Scholar]
  • 7.Jorenby D., Leischow S.J., Nides M.A., Rennard S.I., Johston J.A., Hughes A.R. A controlled trial of sustainedrelease bupropio, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999;340:685–691. doi: 10.1056/NEJM199903043400903. [DOI] [PubMed] [Google Scholar]
  • 8.Tang J.L., Law M., Wald N. How effective is nicotine replacement therapy in helping people to stop smoking? BMJ. 1994;308:21–26. doi: 10.1136/bmj.308.6920.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Fiore M.C., Jorenby D.E., Baker T.B., Kenford S.L. Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. JAMA. 1992;268:2687–2694. [PubMed] [Google Scholar]
  • 10.Dale L.C., Hurt R.D., Offord K.P., Lauson G.M., Croghan I.T., Schroeder D.R. Highdose nicotine patch therapy. Percentage of replacement and smoking cessation. JAMA. 1995;274:1353–1358. [PubMed] [Google Scholar]
  • 11.Fredrickson P.A., Hurt R.D., Lee G.M., Wingender L., Croghan I.T., Lauger G. High dose transdermal nicotine therapy for heavy smokers: safety, tolerability and measurement of nicotine and cotinine levels. Psychopharmacology. 1995;122:215–222. doi: 10.1007/BF02246542. [DOI] [PubMed] [Google Scholar]
  • 12.Silagy C., Mant D., Fowler G., Lancaster T. Nicotine replacement therapy for smoking cessation. In: Lancaster T., Silagy C., Fullerton D., editors. Tobacco addiction. Module of the Cochrane Database of Systematic Reviews (updated 01 December 1997). The Cochrane Collaboration, issue 1. Update Software; Oxford: 1998. [Google Scholar]
  • 13.Jiménez C.A., Solano S., González de Vega J.M., Ruiz M.J., Flórez S., Ramos A. Tratamiento del tabaquismo. Normativa SEPAR. Arch Bronconeumol. 1999;35:499–506. doi: 10.1016/s0300-2896(15)30025-9. [DOI] [PubMed] [Google Scholar]
  • 14.Argimon Pallas J.M., Jiménez Villa J. Doyma; Barcelona: 1991. Métodos de investigación aplicados a la atención primaria de salud. [Google Scholar]
  • 15.Kleinbaum D.G., Kupper L.L., Morgenstern H. an Nostrand Reinhold; Nueva York: 1982. Epidemiologic research. Principles and quantitative methods. [Google Scholar]
  • 16.Epidemiology Program Office. Epi Info 2000 manual. Atlanta: Centres for Disease Control, 2000. Disponible en: http://www.cdc.gov/epiinfo/.
  • 17.Recomendaciones del Comité Nacional de Prevención del Tabaquismo . Libro Blanco sobre el tabaquismo en España. Glosa; Barcelona: 1998. En:Comité Nacional para la Prevención del Tabaquismo; pp. 253–258. [Google Scholar]
  • 18.Plans P., Navas E., Tarín A., Rodríguez G., Galí N., Gayta R. Coste-efectividad de los métodos de cesación tabáquica. Med Clin (Barc) 1995;104:49–53. [PubMed] [Google Scholar]
  • 19.Law M., Tang J.L. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Inter Med. 1995;155:1933–1941. [PubMed] [Google Scholar]
  • 20.Stewart P.J., Rosser W.W. The impact of routine advice on smoking cessation from family physicians. Can Med Assoc J. 1982;126:1051–1054. [PMC free article] [PubMed] [Google Scholar]
  • 21.Jamrozik F., Fowler G., Vessey M. Controlled trial of three different antismoking interventions in general practice. BMJ. 1984;288:1499–1503. doi: 10.1136/bmj.288.6429.1499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Comas A., Suárez R., López M.L., Cueto A. Eficacia del consejo sanitario antitabaco. Medifam. 1994;4:67–74. [Google Scholar]
  • 23.Slama K., Karsenty S., Hirsh A. Effectiviness of minimal intervetion by ge-neral practitioners with their smoking patients: a randomised, controlled trial in France. Tobacco Control. 1995;4:162–169. [Google Scholar]
  • 24.Tonnesen P., Mikkelsen K., Markholst C., Ibsen A., Bendixen M., Pedersen L. Nurse conducted smoking cessation with minimal intervention in a lung clinic: a randomized controlled study. Eur Respir J. 1996;9:2351–2355. doi: 10.1183/09031936.96.09112351. [DOI] [PubMed] [Google Scholar]
  • 25.Jiménez C.A., Barrueco M., Carrión F., Cordovilla R., Hernández I., Matínez E. Intervención mínima personalizada en el tratamiento del tabaquismo. Resultados de un estudio multicéntrico. Arch Bronconeumol. 1998;34:433–436. doi: 10.1016/s0300-2896(15)30370-7. [DOI] [PubMed] [Google Scholar]
  • 26.Martín C., Jane C., Nebot M. Evaluación anual de un programa de ayuda al fumador. Aten Primaria. 1993;12:86–90. [PubMed] [Google Scholar]
  • 27.Strecher V.J., Kreuter M., Den Boer D.J., Kobrin S., Hospers H.J., Skinner CS. The effects of computer-tailoring smoking cessation messages in family practice settings. J Fam Pract. 1994;39:262–270. [PubMed] [Google Scholar]
  • 28.Aleixandre E., Casanova M.A., Mitjas J., Sánchez J., Sanmartín A. Ensayo clínico de dos intervenciones de deshabituación tabáquica en atención primaria. Aten Primaria. 1998;22:424–428. [PubMed] [Google Scholar]
  • 29.Abelin T., Ehrsam R., Imhof P. Clinical experience with a transdermal nicotine system in healthy nicotine dependent smokers. In: Willhelmsen L., editor. Smoking as a cardiovascular risk factor. New strategies for smoking cessation. Hogrefe and Huber; Lewiston: 1991. pp. 35–46. [Google Scholar]
  • 30.Daughton D., Heatley S., Prendergst J. Effect of transdermal nicotine delivery as an adjunct to low-intervention smoking cessation therapy. A randomized, placebo-controlled, double-blind study. Arch Intern Med. 1991;151:749–752. [PubMed] [Google Scholar]
  • 31.Tonnesen P., Norregaard J., Simonsen K., Sawe U. A double blind trial of a 16-hour transdermal nicotine patch in smoking cessation. N Engl J Med. 1991;325:311–315. doi: 10.1056/NEJM199108013250503. [DOI] [PubMed] [Google Scholar]
  • 32.Transdermal Nicotine study Group Transdermal nicotine for smoking cessation: six month results from two multicenter controlled clinical trials. JAMA. 1991;266:3133–3138. [PubMed] [Google Scholar]
  • 33.Imperial Cancer Research Fund General Practice Research Group Effectiveness of nicotine patch in helping people stop smoking: result of a randomised trial in general practice. BMJ. 1993;306:1304–1308. doi: 10.1136/bmj.306.6888.1304. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Russell M.A., Stapleton J.A., Feyerabend C., Wiseman S.M., Gustavsson G., Sawe U. Targeting heavy smokers in general practice: randomised controlled trial of transdermal nicotine patches. Br Med J. 1993;306:1308–1312. doi: 10.1136/bmj.306.6888.1308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Ramón J.M., Bou R., Alkiza M.E., Romea S., Oromf J., Saltó E. Proceso de cambio y sexo como predictores del abandono del consumo de tabaco. Arch Bronconeumol. 1999;35:488–493. doi: 10.1016/s0300-2896(15)30023-5. [DOI] [PubMed] [Google Scholar]
  • 36.Keyler D.E., Hieda Y., Peter J., Pentel P.R. Altered disposition of repeated nicotine doses in rats immunized against nicotine. Nicotine & Tobacco Research. 1999;1:241–249. doi: 10.1080/14622299050011361. [DOI] [PubMed] [Google Scholar]
  • 37.Lerman C., Audrian J., Main D., Caporaso N.E., Bowman E.D., Lockshin B. Evidence suggesting the role of specific genetic factors in cigarette smoking. Healt Psychology. 1999;1:14–20. doi: 10.1037//0278-6133.18.1.14. [DOI] [PubMed] [Google Scholar]
  • 38.Comas A., Suárez R., López M.L., Cueto A. Efectividad a largo plazo del consejo antitabaco en atención primaria: el proceso de recaída. Rev Esp Salud Pública. 1996;70:283–293. [PubMed] [Google Scholar]
  • 39.Guía para ayudar a la gente a dejar de fumar. Programa de actividades preventivas y promoción de la salud de la Sociedad Española de Medicina Familiar y Comunitaria. http://www.almirallprodesfarma.com/quies/g3.html.
  • 40.Córdoba R., Ortega R., Cabezas C., Forés D., Nebot M. Recomendaciones sobre estilo de vida. Aten Primaria. 1999;24(Supl 1):118–132. [Google Scholar]
  • 41.Clemente M.L., Alonso J.A., Córdoba R., Cortada J., Grandes G., Nebot M. Descripción de las guías disponibles en España para el abordaje del tabaquismo en atención primaria. Aten Primaria. 1999;24:101–108. [PubMed] [Google Scholar]
  • 42.Pérez-Trullen A., Marrón R. Guías prácticas de deshabituación tabáquica: qué son, por qué y cómo utilizarlas? Arch Bronconeumol. 1999;35(Supl 3):84–88. [PubMed] [Google Scholar]
  • 43.Pérez-Trullen A., Sánchez Agudo L. Guías prácticas de deshabituación tabáquica: análisis coste-efectividad. Arch Bronconeumol. 1999;35(Supl 3):89–94. [PubMed] [Google Scholar]
  • 44.Cabezas C., Vives A., Ballvé J.L., Berenguer M.D., Monteverde X., Calero S. Validez del registro de las actividades preventivas en las historias clínicas: consumo y consejo antitabaco. Aten Primaria. 1996;18:309–313. [PubMed] [Google Scholar]
  • 45.Carrión F., Furest I., Pascual J.M., Marín I. Intervención mínima en tabaquismo en España. Arch Bronconeumol. 2000;36:124–128. doi: 10.1016/s0300-2896(15)30196-4. [DOI] [PubMed] [Google Scholar]
  • 46.Robinson M.D., Laurent S.L., Little J.M., Jr. Including smoking status as a new vital sig: it works! J Fam Prac. 1995;40:556–561. [PubMed] [Google Scholar]
  • 47.Granollers S., Pont A., Ibeda I. Idoneidad de una consulta de tabaquismo en atención primaria. Aten Primaria. 1995;16:331–336. [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES