Role of the general practitioner in smoking cessation NICHOLAS A. ZWAR & ROBYN L. RICHMOND School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia Abstract This paper reflects on the role of general practitioners in smoking cessation and suggests initiatives to enhance general practice as a setting for effective smoking cessation services. This paper is one of a series of reflections on key issues in smoking cessation. In this article we highlight the extent that general practitioners (GPs) have contact with the population, evidence for effectiveness of GP advice, barriers to greater involvement and suggested future directions. General practice has an extensive population reach, with the majority of smokers seeing a GP at least once per year. Although there is level 1 evidence of the effectiveness of smoking cessation advice from general practitioners, there are substantial barriers to this advice being incorporated routinely into primary care consultations. Initiatives to overcome these barriers are education in smoking cessation for GPs and other key practice staff; teaching of medical students about tobacco and cessation techniques, clinical practice guidelines; support for guideline implementation; access to pharmacotherapies; and development of referral models. We believe the way forward for the role of the GPs is to develop the practice as a primary care service for providing smoking cessation advice. This will require education relevant to the needs of a range of health professionals, provision of and support for the implementation of clinical practice guidelines, access for patients to smoking cessation pharmacotherapies and integration with other cessation services such as quitlines. [Zwar NA, Richmond RL. Role of the general practitioner in smoking cessation. Drug Alcohol Rev 2006;25:21 – 26] Key words: general practice, smoking cessation. Background Over recent years it is clear that smoking cessation is a key strategy for decreasing the burden of smoking related death and disability of populations. There is a long lead-time between initiation of smoking and development of most smoking-related diseases, but there are remarkable health benefits of cessation [1]. According to Peto, ‘if we are to see decreases in the death and disease associated with smoking in our own lifetimes then it will come from current smokers giving up’ [2]. There is a wide range of approaches to smoking cessation, but one with great appeal in countries with an accessible primary care medical work-force is interven- tion through the general practitioner (GP)/family physician. One reason for this is the opportunity afforded through frequent contacts with patients. In Australia, for example, more than 80% of the popula- tion visits a GP at least once per year and most smokers have several visits [3]. Except for the community pharmacist, no other health professional has this degree of contact with the population. There is an expectation that the GP will enquire about smoking status and is seen as a credible and acceptable source of advice on smoking cessation [4]. Evidence of the effect of general practitioner advice to stop smoking Notwithstanding that GPs have a wide reach into the population, is delivery of smoking cessation advice effective and practical? Michael Russell pioneered investigation on this question in Britain. Russell’s research demonstrated that advice to patients from their GP to stop smoking is effective [5]. Since this early work, the effect of brief advice has been studied extensively and is the subject of a number of meta- analyses. The Cochrane Review on the effect of physician advice on smoking cessation examined Nicholas A. Zwar MBBS, PhD, FRACGP, Professor of General Practice, School of Public Health and Community Medicine, University of New South Wales, UNSW Sydney 2052, Australia, Robyn L. Richmond PhD, MA, MHEd, Professor of Population Health, School of Public Health and Community Medicine, University of New South Wales, UNSW Sydney 2052, Australia. Correspondence to Nicholas A. Zwar, School of Public Health and Community Medicine, University of New South Wales, UNSW Sydney 2052, Australia. Tel: 61 2 96168520; Fax: 61 2 96168400; E-mail: n.zwar@unsw.edu.au Received 24 June 2005; accepted for publication 11 August 2005. Drug and Alcohol Review (January 2006), 25, 21 – 26 ISSN 0959-5236 print/ISSN 1465-3362 online/06/010021–06 ª Australasian Professional Society on Alcohol and Other Drugs DOI: 10.1080/09595230500459487