27 research outputs found
Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial)
Background: The German clinical guideline on tobacco addiction recommends that general practitioners (GPs)
provide brief stop-smoking advice to their patients according to the â5Aâ or the much briefer âABCâ 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 propose
[Oral healthcare for frail and care-dependent older people in Germany and the Netherlands].
Item does not contain fulltextTo improve oral health for frail and care-dependent older people, both intra- and extramurally, in the Euregio Rhine-Waal area in the Netherlands and Germany, we inventoried barriers to oral care for the target group according to the literature, the organisation of oral care in both countries and the implications of this organisation for daily and professional (oral) healthcare and oral care. Results show most identified barriers are common to both countries, but the organisation of oral healthcare differs in both countries. The main differences lie in the financing and organisation of oral care in the intramural situation. In the Netherlands, this is to a large degree regulated and organised on the basis of the Chronic Care Act (Wlz), using the Verenso Oral Care Directive for care-dependent clients as a base for enforcement. In Germany, on the other hand, the provision of oral care in the home situation is more effectively facilitated. In both countries, various initiatives have recently been employed to improve, among other things, information supply, education and financing of oral healthcare.1 november 201
Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice - ABC versus 5As
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 â independently of the receipt of GP advice â recruited before or after the training of 69 GPs. At week 26, âŒ70% 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 patientsâ loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPsâ advice into patientsâ behaviour change