[The physician and the patient in the decision to quit smoking. Effect of the initiative on the result of the intervention].

Introduction: The results obtained from treatment of smoking addiction are not all that might be desired, such that continued investigation of the various factors that determine treatment success or failure are necessary. The aim of this study was to know the influence of health care providers in the smoking cessation process.

Material And Methods: We performed a prospective, longitudinal study of patients at a primary care facility and a specialized unit. Two types of intervention were performed: minimal intervention with patients with a low level of dependence and nicotine patch substitution treatment (Nicotinell) (NST) in patients with moderate-to-high dependence.

Results: The total number of smokers enrolled was 427: 206 at the primary care facility (87 who requested treatment and 119 to whom enrollment was recommended) and 21 at the respiratory medicine unit (79 who requested treatment and 142 to whom enrollment was recommended). One year after minimal intervention, abstinence was 36.8% (27.2%-47.4%) at the primary care center and 41.8% (31.9%-52.2%) at the specialized unit (p > 0.05). Abstinence in the NST group at each center was 35.3% (24.1%-47.8%) and 35.5% (25.8%-46.1%), respectively (p > 0.05). With minimal intervention, 40% (16.3%-67.7%) of those who had requested enrollment had quit smoking one year after starting, versus 36.3% (32.1%-46.9%) of those to whom it had been recommended (p > 0.05); in the NST group, the percentages were 33.3% (24.4%-43.2%) and 39.3% (26.5%-53.2%) (p > 0.05). The percentage of abstinence among smokers in pre-contemplation phase was 28.4% (18.5%-40.1%) one year after starting; among those in the contemplation phase, abstinence at one year was 49.2% (36.6%-61.9%) (p < 0.05). The patients whose enrollment was the result of physician recommendation had better outcomes (odds ratio of 0.244 [95% CI: 0.097-0.616]).

Conclusions: Intervention among smokers should be as strong among those who ask for help as among those who have not yet contemplated quitting; progress to another phase in the abandonment process, so that efforts to achieve total cessation can be approached at a later time, should be considered a therapeutic success.