Tobacco control has been identified as the most urgent and immediate priority intervention to reduce the prevalence of non-communicable disease. Nevertheless, a substantial gap exists between the... Show moreTobacco control has been identified as the most urgent and immediate priority intervention to reduce the prevalence of non-communicable disease. Nevertheless, a substantial gap exists between the evidence-based knowledge on the treatment of tobacco dependence and real-world practices of primary care professionals. The empirical studies in this dissertation provided insight in a variety of methodological approaches that can be used to describe and facilitate the implementation of smoking cessation care in general practice. This resulted in study findings showing that a training programme for GPs including action planning has the potential to facilitate the implementation of smoking cessation care, in particular the degree to which smokers are identified and advised to quit. In addition, full health insurance coverage of stop-smoking programmes increased GP prescription behaviour. Yet, challenges remain to incorporate smoking cessation care as a routine procedure in general practice, with a special focus on arranging follow-up support by GPs. This dissertation provided several new ideas for future research in order to overcome these challenges. Multifaceted strategies, based on a socio-ecological approach to guideline implementation and including behavioural change theories, have the potential to facilitate a successful implementation of smoking cessation care in general practice. Show less
Verbiest, M.E.A.; Crone, M.R.; Scharloo, M.; Chavannes, N.H.; Meer, V. van der; Kaptein, A.A.; Assendelft, W.J.J. 2013
INTRODUCTION This study examined the effectiveness of low-intensity, practice-tailored training for general practitioners (GPs) aimed at personal and organizational barriers that arise when... Show moreINTRODUCTION This study examined the effectiveness of low-intensity, practice-tailored training for general practitioners (GPs) aimed at personal and organizational barriers that arise when routinely asking patients' smoking status, advising to quit, and arranging follow-up. METHODS A cluster-randomized controlled trial with 49 GPs and 3,401 patients (677 smokers). Two patient groups participated: 2,068 patients (433 smokers) at baseline and 1,333 patients (244 smokers) postintervention. At follow-up, 225 smokers of both groups participated. The primary outcome was GP smoking cessation counseling (asking about smoking status, advising to quit, prescribing pharmacotherapy, and referring for behavioral support). Secondary outcomes were GPs' attitudes toward smoking cessation care, patients' intention to quit, and long-term quit rates. Outcomes were measured with GP self-report and patient report. RESULTS Patients of trained GPs reported more often being asked about smoking behavior compared to patients of untrained GPs (OR = 1.94, 95% CI = 1.45-2.60). According to GP self-report, the training increased the provision of quit-smoking advices (difference 0.56 advice per day; 95% CI = 0.13-0.98) and the ability and intention of providing smoking cessation care. We found no effect on GPs' arrangement of follow-up, smokers' intention to quit, and long-term quit rates. CONCLUSIONS After 1 hour of training, we found significant differences between trained and untrained GPs on the frequency in which they asked about smoking (patient reported) and advised smokers to quit (GP self-reported). The training did not increase prescriptions of pharmacotherapy, referrals to behavioral support, or quit rates. Future training methods should focus on the GPs' ability, tools, and skills to arrange follow-up to ensure intensive smoking cessation support. Show less
AIMS To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. DESIGN Ecological study with interrupted time... Show moreAIMS To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. DESIGN Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases. SETTING The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners (GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011. PARTICIPANTS GPs, pharmacists and people in the general population aged 15 years and older. MEASUREMENTS Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions. FINDINGS No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval (CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000). CONCLUSIONS Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence. Show less
