Smoking cessation treatment in primary care: prospective cohort study

Objective: To compare the characteristics of smokers who do and do not receive smoking cessation treatment in primary care. Design: Prospective cohort study using practices registered with the pilot QRESEARCH database. Setting: 156 550 patients aged 18 years and over from 39 general practices located within four strategic health authorities, representing the former Trent Region, UK. Subjects: Patients registered with practices between 1 April 2001 and 31 March 2003 aged 18 years and over who were identified as smokers before the two year study period. Outcome: Prescription for smoking cessation treatment (nicotine replacement therapy (NRT) or bupropion) in the two year study period. Variables: Age, sex, deprivation score, co-morbidity. Results: Of the 29 492 patients recorded as current smokers at the start of the study period 1892 (6.4%) were given prescriptions for smoking cessation treatment during the subsequent two years. Of these, 1378 (72.8%) were given NRT alone, 406 (21.5%) bupropion alone, and 108 (5.7%) both treatments. Smokers were more likely to receive smoking cessation treatment if they lived in the most deprived areas (odds ratio (OR) for the most relative to the least deprived fifth, adjusted for sex, age, and co-morbidity, 1.50, 95% confidence interval (CI) 1.26 to 1.78), and if they were aged 25 - 74 years compared to 18 - 24 years or 75 and over. Smokers with co-morbidity were also more likely to receive smoking cessation treatment. Smokers were less likely to receive smoking cessation treatment if they were male (adjusted OR 0.68, 95% CI 0.62 to 0.75). Conclusion: The low proportion of smokers being prescribed these products strongly suggests that a major public health opportunity to prevent smoking related illness is being missed.