No institution

except the Zurich centre offered structured programmes during the study period. Nearly all institutions reported providing – in addition to ‘standard care’ – ‘frequent short counselling’, half of the institutions reported offering ‘detailed counselling’ if indicated, and around half reported handing out information booklets. Also, institutions reported using nicotine substitution, or prescribing bupropion or varenicline in some patients. All institutions reported referring patients to specialized addiction treatment institutions if the patient so wished. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants had 6068 cohort visits, and 46% smoked at their last visit (Table 1). Smoking status checklists were not available for 739 of 6068 visits (12%) and incomplete DAPT for 208 (3.4%), so that 5121 (84%) completed checklists were available. Visits with missing checklists were more likely to arise for nonsmoking participants (56%) than for currently smoking participants (44%). There was variation in the number of missing checklists between physicians (data not shown). Current smoking was

declared in 44.5% of the completed checklists. Among the 2374 checklists for those currently smoking, motivation was assessed as: 85 (3.6%) intended to stop immediately; 262 (11%) intended to stop within 6 months; 804 (33.9%) would stop later; 784 (33%) did not intend to stop; and 439 (18.5%) did not answer. Smoking cessation counselling was carried out in 1888 of 2374 visits (80%) for current smokers. Reasons for not counselling were: other priorities (50%), patient refusal (19%), lack of time (12%) Everolimus nmr and other reasons (18%). Among counselled participants, the following types of most additional support were given (multiple types per patient possible): distribution of handout (8.1%), detailed counselling (6.5%), varenicline prescription (3.8%), nicotine substitution

(2.5%), follow-up date arranged (2.4%), agreed upon stop date (1.5%), bupropion prescription (0.9%), and referral to specialized institution (0.2%). Changes in motivation were very common (Table 2), with the exception of persons who did not smoke, of whom 95% remained nonsmokers. In smokers, the probability of a change in motivation level between two visits was more than 50% (diagonal elements in Table 2). The probability of changing from smoking to not smoking between two visits strongly depended on the motivation level, with 14% among persons ready for an immediate stop and 13% among those intending to stop within the next 6 months, but only 5.3% for persons who indicated to stop later, and 5.1% for those who were not motivated at all. When compared with ‘no motivation’, the odds ratios (95% confidence intervals) for not smoking at the next visit were 1.9 (0.85–4.2) for ‘immediate stop’, 2.1 (1.2–3.8) for ‘stop within 6 months’, and 1.0 (0.61–1.7) for ‘stop later’.