Our longitudinal observations suggest that dementia risk may be reduced by some but not all types of mental work demands.

Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register ( DRKS00012786 ); registered on 22th August 2017, prior to the first patient in. Electronic supplementary material The online version of this article (10.1186/s12875-019-0986-8) contains supplementary material, which is available to authorized users.

This study assessed the effectiveness of a 3.5h-training for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice – ABC versus 5As – on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations.Pragmatic, two-arm cluster randomised controlled trial including a pre-post-design for the analyses of the primary outcome in 52 GP practices (Germany). Practices were randomised (1:1) to receive a 3.5h-training (ABC or 5As). In total, 1937 tobacco smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training were included. Primary outcome: patient-reported rates of GP-delivered stop-smoking advice prior and following the training, irrespective of the training method. Secondary outcomes: patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy, or combination therapy for smoking cessation; and the effectiveness of ABC versus 5As regarding all outcomes.GP-delivered stop-smoking advice increased from 13.1% (n=136/1039) to 33.1% (n=297/898) following the training (aOR=3.25, 95%CI=2.34 to 4.51). Recommendation/prescription rates of evidence-based treatments were low (<2%) pre-training, but had all increased after the training (e.g., behavioural support: aOR=7.15, 95%CI=4.02 to 12.74). Delivery of stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC versus 5As group (aOR=1.71, 95%CI=0.94 to 3.12).A single training session in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered advice during routine consultations.

OBJECTIVE To assess the effectiveness of a 3.5h-training for general practitioners (GPs) in two different methods (ABC, 5As) of giving brief stop-smoking advice during routine consultations. DESIGN Pragmatic two-arm cluster randomised controlled trial with pre-post-design for the primary outcome and cluster randomisation for secondary outcomes. SETTING General practices, North Rhine-Westphalia (German federal state), recruited 2017-2019. PARTICIPANTS Practices were randomised (1:1) to an ABC or 5As training. Tobacco smoking, adult patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training were eligible to participate. Ineligible were: non-smokers, patients who did not meet the GP in person, or could not provide informed consent. INTERVENTIONS Two different standardised 3.5h-trainings (ABC or 5As) for GPs in delivering brief stop-smoking advice were carried out per study cycle (six cycles in total). Trainings were moderated by a senior researcher and an experienced GP, and included role-plays with professional actors. MAIN OUTCOME MEASURES Primary outcome: patient-reported rates of GP-delivered stop-smoking advice prior and following the training, irrespective of the training method. Secondary outcomes: patient-reported receipt of recommendation/prescription of evidence-based smoking cessation treatment: including behavioural support, any pharmacotherapy (nicotine replacement therapy (NRT), varenicline, or bupropion), or a combination therapy; and the effectiveness of ABC versus 5As regarding all outcomes. RANDOMISATION AND MASKING Computer-generated block randomisation or, if not feasible, randomisation based on the GPs′ temporal availability at training dates. GPs were not fully blinded. Patients were blinded to the nature of the study until data collection ended. RESULTS 52 GP practices (27 ABC, 25 5As) with 69 GPs were included. Of 5,406 patients who provided informed consent, 1,937 (35.9%) were current smokers, of whom 1,039 were interviewed prior to and 898 following the training. GP-delivered stop-smoking advice increased from 13.1% (n=136/1,039) to 33.1% (n=297/898) following the training (adjusted odds ratio (aOR)=3.25, 95%CI=2.34 to 4.51). Recommendation/prescription rates of treatment were low (<2%) pre-training, but had increased after the training (e.g., behavioural support: aOR=7.15, 95%CI=4.02 to 12.74; any pharmacotherapy: aOR=7.99, 95%CI=4.11 to 15.52). GP-delivered stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC vs. 5As group (aOR=1.71, 95%CI=0.94 to 3.12). CONCLUSIONS In GPs in Germany, a single session of training in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered stop-smoking advice during routine consultations. Approaches to further increase the delivery of such advice, and upscaling implementation strategies for the training in general practice, should be evaluated. TRIAL REGISTRATION German Clinical Trials Register: DRKS00012786.

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.