Guide to support smoking cessation makes the GRADE

The Royal Australian College of General Practitioners (RACGP) has recommended allowing greater flexibility in prescribing pharmacotherapy for smoking cessation.

The proposal is contained in the RACGP’s newly released Supporting smoking cessation: A guide for health professionals (2nd edition) and, according to the RACGP, could prove to be a “game-changer” for reducing smoking rates in Australia.

Recommendations in the guide are based on research conducted by JBI at the University of Adelaide, together with experts at the JBI Adelaide GRADE Centre, who were commissioned by the RACGP to assist with revising the guide for the second edition.

A team of researchers led by Associate Professors Zachary Munn and Edoardo Aromataris undertook the appraisal, extraction and synthesis of the best-available evidence to support Australians to quit smoking.  

“We adhered to GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to conduct a review of the evidence and assess the certainty of the findings from the available research.  Following this we applied the transparent and systematic processes of the GRADE evidence to decision framework with the RACGP Expert Advisory Group to develop recommendations from the evidence. The GRADE approach represents current best practice in clinical guideline development”, said Associate Professor Edoardo Aromataris.

A key finding of this research was that combination pharmacotherapy is superior to monotherapy. Combination pharmacotherapy includes combination nicotine replacement therapy (NRT), which is the use of two forms of NRT together, for example using both a nicotine patch and nicotine gum to help quit smoking. Using Varenicline, a drug which blocks the pleasure and reward response to smoking, and NRT together is another type of combination cessation therapy.

"By using the GRADE approach to developing recommendations, we have been able to clearly show how certain we are that a particular treatment strategy is superior”, said Associate Professor Zachary Munn.

At present combination NRT, or NRT combined with pharmacotherapy-based cessation such as Varenicline, are not PBS-subsidised.  

Based on these recommendations in the revised RACGP guide, experts are calling for subsidisation of combination cessation therapy to consumers.  

“…We have fixed PBS rules that don’t reflect best practice medical assistance. As a result, people trying to quit smoking miss out on PBS subsidies that could make a real difference”, RACGP President Dr Harry Nespolon said. 

“The science is in … Varenicline or combination NRT almost triples the odds of quitting … The evidence is also clear that combination NRT is most effective”, Dr Nespolon added.

The guide update was funded by VicHealth and the Australian Government Department of Health. 

Access the guide, Supporting smoking cessation: A guide for health professionals (2nd edition)