Effectiveness of training general practitioners in the ABC versus 5As method of delivering brief stop-smoking advice: a pragmatic, two-arm cluster randomised controlled trial

Abstract

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.

Mental Health Symptoms and Associations with Tobacco Smoking, Dependence, Motivation, and Attempts to Quit: Findings from a Population Survey in Germany (DEBRA Study)

“…In addition, HPs should be trained to further encourage, and effectively support, smokers with MHCs in translating their motivation to quit into successful abstinence. Training in the effective treatment of tobacco addiction is not standard in the medical education in Germany, although such training can substantially increase HPs’ provision of advice on smoking cessation and of recommendation on the use of evidence-based cessation treatments [55]. For smokers with MHC who are motivated to quit but have difficulties to achieve abstinence, medical counselling and, in particular, the recommendation of evidence-based behavioural support and cessation medication are of particular importance [21].…”

Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention

“…As described in WP1, we calculate with an estimate of 20% of patients who report the receipt of brief PA advice during their GP visit without the GP having been trained. Another study showed that a brief singlesession GP training can increase patient-reported rates of GP-delivered stop-smoking advice by 20%points on average (52). Training GPs to deliver PA advice might be more challenging, e.g., because PA recommendations are more complex than simple advice on smoking cessation methods.…”

“…All patients will be included in an intention-to-treat analysis. Based on experiences from another cRCT (52), missing data on the primary outcome is assumed to be minimal as data will be collected through face-to-face interviews. However, multiple imputation will be applied to impute missing data if needed.…”

Lung cancer

“…It is critical to address a patient's cigarette smoking at each clinic visit. Providers can use the ABC pathway for smoking cessation: Ask about and document every person's smoking status, give Brief advice to stop smoking to each patient who smokes, strongly encourage every person who smokes to use Cessation support (offer to help them access it; refer to, or provide, cessation support to everyone who accepts your offer) 7…”