A new quality improvement project examines smoking cessation practices in primary care and the realities facing patients and providers.

Smoking 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.

“Investing more resources in smoking cessation services upfront could lead to significant downstream benefits across the health system.”

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.

Dr. Christopher Carlsten is director of the Centre for Lung Health, the Legacy for Airway Health and the Air Pollution Exposure Laboratory. He is the Canada Research Chair in Occupational and Environmental Lung Disease, professor and head of the Respiratory Medicine Division at the University of British Columbia (UBC) and an associate faculty member in the UBC School of Population and Public Health.

“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.

“For smoking cessation to be effective in complex cases, providers need sufficient time, training and system support to deliver ongoing care.”

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.

Carlsten suggests that mobile, multidisciplinary teams could bring smoking cessation expertise, respiratory diagnostics and rehabilitation services directly to communities with limited access to care. These teams could include counsellors, prescribing clinicians and other specialists working together to provide comprehensive support closer to home.

“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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