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Effects of practitioner education, practitioner payment and reimbursement of patients’ drug costs on smoking cessation in primary care: a cluster randomised trial
  1. Dorothee Twardella,
  2. Hermann Brenner
  1. Department of Epidemiology, German Center for Research on Ageing, Heidelberg, Germany
  1. Correspondence to:
 H Brenner
 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Str 20, D-69115 Heidelberg, Germany; h.brenner{at}


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

Design: Cluster randomised trial, 2×2 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.

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  • Funding: This study was funded by the German Ministry of Education and Research (Bundesministerium für Bildung und Forschung), project number 01EB0113, within the context of the Baden–Württemberg Research Network on Addiction (project 01EB0113).

  • Competing interests: None.

  • The funding source was not involved in study design, collection, analysis or interpretation of data, in writing of the report or in the decision to submit the paper for publication.

    Ethical approval: The study was approved by the ethics board of the University of Heidelberg and by the ethics board of the medical association of the State of Baden–Wuerttemberg.