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The serious health effects of smoking are indisputable. Smoking is responsible for 20% of the deaths in most Western countries, shortens the life expectancy of addicts by an average of eight years and adds a huge and preventable burden of disease to over-stretched health systems.1 Despite this, progress both in primary prevention of addiction, using legislative and fiscal restrictions, and secondary prevention, using smoking cessation programmes and population-based interventions, has been slow.
Brief, opportunistic advice on stopping smoking and non-tailored smoking cessation letters both increase cessation rates by 2-3%.2 There are a number of randomized controlled trials supporting the effectiveness of nicotine replacement therapy (NRT). A systematic review in 1994 found an overall, one-year quit rate of 15%.3 A meta-analysis in the same year found an overall quit rate of 22% at six months. A recent Cochrane review of NRT efficacy included studies with endpoints six months and beyond. An overall 14% quit rate was calculated.4
A number of other interesting points were highlighted in this review, including the fact that a key determinant of programme success is the setting in which it is offered, with studies set in primary care showing smaller effect than those in specialised clinics or studies using volunteers. Suggested reasons for this were training differences, as well as the often-encountered problems of translating research evidence into 'real world' general practice - it was felt that differential rates reflected the selection of motivated volunteers compared with the more heterogeneous general practice population. This differential rate of success is of some concern as the general practice sector would regard smoking cessation to be one of its core functions, and delivery of smoking cessation programmes in primary care has been shown to be cost effective.5
There is a great deal of interest in addressing cardiovascular risk factors in the primary care setting, and in the utility and funding of smoking cessation and NRT in community settings. Despite evidence that in New Zealand general practitioners (GPs) provide smoking cessation to many patients, a recent study showed that New Zealand smokers are not well informed about smoking cessation strategies and their efficacy.6 A recent paper found differences between actual and recommended practice in primary care in New Zealand and identified a number of potential barriers...