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Archived Comments for: Quit in General Practice: a cluster randomised trial of enhanced in-practice support for smoking cessation

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  1. Does provision of free medication represent usual care?

    Oliver Frank, University of Adelaide

    28 March 2011

    This is an important study and a well-designed trial overall, and I look forwards to seeing the findings. I would like to comment on the issue of aiming to have a 'usual care' control group.

    The investigators say: "Practices will be allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline Referral 3) usual care control group", but later state: "For patients in all three groups who are on low incomes and therefore eligible for subsidised medicines under the Australian Government Pharmaceutical Benefit Scheme (PBS) the project will fund access to nicotine patches."

    The investigators justify this with: "This targeted subsidy will not disrupt the ecological validity of the study as a test of the different modes of cessation support as it will be offered equally across all three arms of the study".

    The third group of practices will not be offering usual care, but instead will be offering free medication plus whatever other care the doctors and nurses choose to give. I would be happier to see the treatment to be provided by the third group described in these or similar terms.

    Since the protocol was published, nicotine patches have been made available in Australia on the Pharmaceutical Benefits Scheme, which has greatly reduced the price that low income earners have to pay for them, but the principle remains the same. Provision of medication that would normally cost the patient something cannot be represented as usual care.

    Would it help to have a fourth group of practices that are in fact free to provide whatever care they usually would?

    Competing interests

    No competing interests