Taking a closer look at smoking cessation in primary care

HN Summary

• A quality improvement project led by Vancouver Coastal Health Research Institute identified key barriers that limit smoking cessation support in primary care, including insufficient time, limited resources and gaps in provider training. 

• Researchers found opportunities to strengthen care through improved compensation models, streamlined referral pathways, enhanced patient education and expanded training in smoking cessation counselling. 

• The findings also highlight the need to improve access to smoking cessation services for underserved populations, particularly people in remote communities and those facing complex health and social challenges.

moking rates in British Columbia have decreased significantly over the past several decades, yet approximately eight to 10 per cent of people still smoke. Tobacco use remains a leading cause of preventable disease, reinforcing the need for accessible and effective smoking cessation support.

A new quality improvement project is helping researchers better understand why many people continue to struggle with quitting smoking and what changes could strengthen smoking cessation care in primary care settings. Published in BMJ Open Quality, the project explored how primary care providers in British Columbia perceive tobacco use disorder and the barriers they face when supporting patients through smoking cessation treatment.

Led by Dr. Christopher Carlsten and colleagues at the Vancouver Coastal Research Institute researcher (VCHRI), the project surveyed 198 family physicians and nurse practitioners across the province using an integrated knowledge translation approach. Clinicians, policy analysts, tobacco cessation experts and patient partners were involved throughout the design, implementation and interpretation of the project, helping ensure the findings reflect real world clinical experiences and patient needs.

“Primary care plays a central role in smoking cessation because it is often a patient’s first point of contact with the health care system,” says Carlsten. “Investigating the unique perspectives of primary care providers across the province allows us to develop solutions that align with their needs and maximize impact for patients.”

Identifying barriers to smoking cessation in everyday practice

The survey findings revealed three key themes with important implications for smoking cessation policy, practice and research: time and compensation, communication and resources, and education and awareness. 

Insufficient time was identified as the most significant barrier to providing effective smoking cessation treatment. Researchers highlighted several opportunities for improvement, including revisiting compensation structures to better reflect the time required for counselling and follow-up care, improving clinical workflows and creating opt-out referral pathways to connect patients with support services earlier.

Survey respondents also emphasized the need for additional resources to support consistent, efficient communication with patients, including concise guidance materials on tobacco use disorder, treatment options and medication and coverage. 

The findings further highlighted the importance of comprehensive and accessible training to improve provider confidence and patient outcomes. Areas for skill development could include motivational interviewing, strategies to address patient barriers to quitting and tailored approaches for supporting marginalized populations.

Improving access for underserved communities

The project also identified opportunities to improve smoking cessation support in underserved and remote communities, where access to specialized care can be limited.

“People who face the greatest barriers to quitting smoking, such as those living with mental illness, substance use disorders or in remote communities, often require the most intensive support,” says Carlsten. “That is why it is important to understand how primary care settings can better support smoking cessation for this population.”

Beyond clinical solutions, the research underscores the importance of continued leadership, advocacy and investment in smoking cessation initiatives across the health system.

“Although smoking rates have plateaued, tobacco use remains a major public health issue,” Carlsten adds. “We’ve made a great deal of progress, and there is more we can do to improve care and reduce preventable disease.”

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