Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice (ABC versus 5As)
- Sabrina Kastaun1⇑,
- Wolfgang Viechtbauer2,
- Verena Leve1,
- Jaqueline Hildebrandt1,
- Christian Funke1,
- Stephanie Klosterhalfen1,
- Diana Lubisch1,
- Olaf Reddemann1,
- Tobias Raupach3,4,
- Stefan Wilm1 and
- Daniel Kotz1,4,5
- 1Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- 2Department of Psychiatry and Neuropsychology, Maastricht University, MD Maastricht, Netherlands
- 3Institute for Medical Education, University Hospital Bonn, Bonn, Germany
- 4Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, WC1E 6BLondon, UK
- 5Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, MD Maastricht, The Netherlands
- Dr. Sabrina Kastaun, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany. E-mail: Sabrina.Kastaun{at}med.uni-duesseldorf.de
Abstract
We developed a 3.5 h-training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12, and 26 following GP consultation.
Follow-up data were collected in 1937 smoking patients – independently of the receipt of GP advice – recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed.
Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not, had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26.
We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients’ loss to follow-up or to contextual factors – e.g., access to free evidence-based cessation treatment – which can hamper the transfer of GPs’ advice into patients’ behaviour change.
Footnotes
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Conflict of interest: Dr. Kastaun has nothing to disclose.
Conflict of interest: V. Leve has nothing to disclose.
Conflict of interest: V. Leve has nothing to disclose.
Conflict of interest: J. Hildebrandt has nothing to disclose.
Conflict of interest: C. Funke has nothing to disclose.
Conflict of interest: S. Klosterhalfen has nothing to disclose.
Conflict of interest: D. Lubisch has nothing to disclose.
Conflict of interest: O. Reddemann has nothing to disclose.
Conflict of interest: Dr. Raupach reports personal fees from Pfizer, Novartis, Glaxo Smith Kline, Astra Zeneca and Roche as a speaker in activities related to continuing medical education, grants from Pfizer and Johnson & Johnson, outside the submitted work; .
Conflict of interest: S. Wilm has nothing to disclose.
Conflict of interest: D. Kotz has nothing to disclose.
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- Received March 31, 2021.
- Accepted May 23, 2021.
- Copyright ©The authors 2021
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