Diverse provenience in a smoking cessation program: is there a difference?

Introduction: Smoking cessation programs offer an effective way to quit smoking. In Portugal these programs receive patients from primary care and all areas of secondary/tertiary care. Objective: to compare patients who attended a smoking cessation program referred from primary care(PC) with those from a hospital facility(HF). Methods: retrospective study conducted among patients who attended a smoking cessation program in a Lisbon central hospital, between 2017-2018. Demographic data, smoking pack-years, nicotine dependence, motivation to quit, anxiety and depression (assessed by Fagerstrom Test, Richmond Test and Hospital Anxiety Depression Scale, respectively) and quit smoking success were collected. Success rate was defined as non-smoking for ≥3 months. Results: total sample of 285 patients, 224(78.6%) from HF and 61(21.4%) from PC. Both had similar mean age. HF patients had a higher mean smoking pack-years (HFvsPC, 41±21.8vs38±21.7) and more respiratory comorbidities (HFvsPC, 43.3%vs34.4%). PC patients had more anxiety (mean score 9.6±4.2vs8.5±4.3) and depression (mean score 6.4±3.7vs6.0±3.7). On average, both groups had a moderate nicotine dependence and motivation to quit, only 6.6% of PC and 8.8% HF patients were highly motivated. The overall success rate was higher in HF patients-14.7%vs4.9% (p-value 0.04), rising to 26%vs8.3% in those who attended ≥3sessions. Conclusion: Patients referred from a HF had more respiratory comorbidities and higher smoking load, probably felling more benefits with smoking cessation. They were less anxious and depressed, allowing an easier intervention. Considering the small percentage of highly motivated patients, it should be a better selection for these programs.