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Cited by 84Smoking Behavior and CessationPrimary Care and Health OutcomesSubstance Abuse Treatment and Outcomes

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

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Twardella, Dorothee, Brenner, Hermann·2007·Tobacco Control
DOI 10.1136/tc.2006.016253PMC PMC2598437
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Abstract

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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  • A smoking cessation implementation trial examined whether direct patient reimbursement for medication and/or physician group training affected medication use, with patients nested in physicians and all four combinations tested.

    “An example of this design is a trial for smoking cessation implementation, testing whether direct patient reimbursement for medication and/or physician group training influence the use of these medications. Patients are nested within physicians, and all four combinations are tested (107).”

    From An Overview of Research and Evaluation Designs for Dissemination and Implementation (2017) · cites this paper as [107]

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Authors
Twardella, D., & Brenner, H.
Affiliations
Heidelberg University (DE)
Corresponding author
Brenner, Hermann
ORCID
Brenner, Hermann
Venue
Tobacco Control
Publisher
BMJ
Published
2007-02
Volume
16
Issue
1
Pages
15-21
ISSN
  • 0964-4563 (ISSN-L)
  • 1468-3318
DOI
10.1136/tc.2006.016253
PMC
PMC2598437
OpenAlex
W1977122622
Cited by
84
References
30
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 2 · 2015: 4 · 2014: 8 · 2013: 8 · 2012: 6
FWCI
5.56
Type
journal article
Language
en
Open access
Locations
  • Tobacco Control (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
smoking cessation, general practitioners, physician training, financial incentives, nicotine replacement therapy, bupropion, smoking abstinence, primary care, tobacco dependence treatment
MeSH terms
Adult, Aged, Cotinine, Delivery of Health Care, Health Expenditures, Family Practice, Female, Germany, Humans, Male, Middle Aged, Physicians, Family, Primary Health Care, Self Disclosure, Cluster Analysis, Logistic Models, Smoking Cessation

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