Effects of practitioner education, practitioner payment and reimbursement of patients' drug costs on smoking cessation in primary care: a cluster randomised trial

Tob Control. 2007 Feb;16(1):15-21. doi: 10.1136/tc.2006.016253.

Abstract

Objective: To evaluate new strategies to enhance the promotion of smoking cessation in general practice.

Design: Cluster randomised trial, 2x2 factorial design.

Setting: 82 medical practices in Germany, including 94 general practitioners.

Participants: 577 patients who smoked at least 10 cigarettes per day (irrespective of their intention to stop smoking) and were aged 36-75 years.

Interventions: Provision of a 2-h physician group training in smoking cessation methods and direct physician payments for every participant not smoking 12 months after recruitment (TI, training+incentive); provision of the same training and direct participant reimbursements for pharmacy costs associated with nicotine replacement therapy or bupropion treatment (TM, training+medication).

Main outcome measure: Self-reported smoking abstinence obtained at 12 months follow-up and validated by serum cotinine.

Results: In intention-to-treat analysis, smoking abstinence at 12 months follow-up was 3% (2/74), 3% (5/144), 12% (17/140) and 15% (32/219) in the usual care, and interventions TI, TM and TI+TM, respectively. Applying a mixed logistic regression model, no effect was identified for intervention TI (odds ratio (OR) 1.26, 95% confidence interval (CI) 0.65 to 2.43), but intervention TM strongly increased the odds of cessation (OR 4.77, 95% CI 2.03 to 11.22).

Conclusion: Providing cost-free effective drugs to patients along with improved training opportunities for general practitioners could be an effective measure to achieve successful promotion of smoking cessation in general practice.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cluster Analysis
  • Cotinine / blood
  • Delivery of Health Care / economics
  • Delivery of Health Care / methods*
  • Family Practice
  • Female
  • Germany
  • Health Expenditures
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Physicians, Family / education
  • Primary Health Care
  • Self Disclosure
  • Smoking Cessation / economics
  • Smoking Cessation / statistics & numerical data*

Substances

  • Cotinine