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246 Combining default choice and an encounter decision aid to improve tobacco cessation in primary care patients: a pragmatic, cluster-randomized trial
  1. Kevin Selby1,
  2. Inès Habfast-Robertson1,
  3. Christina Hempel-Bruder1,
  4. Anne Boesch1,
  5. Marie-Anne Durand1,2,
  6. Mohamed Faouzi1,
  7. Joachim Marti1,
  8. Yasser Kazaal3,
  9. Hubert Maisonneuve4,5,
  10. Ivan Berlin6
  1. 1Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
  2. 2CERPOP, UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
  3. 3Department of addiction medicine, CHUV, Lausanne, Switzerland
  4. 4University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
  5. 5University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France
  6. 6Hospital Pitié-Salpêtrière, Paris, France

Abstract

Background General practitioners (GPs) less often prescribe treatments for smoking cessation than for other major risk factors. We assessed the effect of training GPs to offer smoking cessation treatments as the default choice using an encounter decision aid (DA).

Methods We conducted a pragmatic, cluster-randomized controlled trial, randomizing GPs in private practice in Switzerland and France to intervention or control trainings. The intervention was a half-day course teaching the default choice approach using an encounter DA (paper or electronic). Control GPs received a 1-hour refresher training on treatment prescribing. GPs recruited daily smokers seen for routine care. The primary outcome was 7-day, point prevalence smoking abstinence at 6 months. Secondary outcomes were quit attempts and use of smoking cessation aids at 3-weeks, 3-months and 6-months.

Results 42 GPs were randomized and completed the training, of whom 34 (81%) recruited patients (82% Swiss, 68% women). The GPs recruited 287 current smokers (51% women, mean age 48, and 77% smoking <1 pack/day), of whom 221 responded at 6 months (77%). Primary and secondary outcomes are presented in the table 1.

Discussion The intervention did not affect self-reported smoking abstinence rate at any time point. It did however increase the number of quit attempts at 3-weeks and the use of smoking cessation aids at the 3-week and 3-month follow-ups.

Conclusion Training GPs to use a decision aid did not improve smoking abstinence, despite short- term increases in quit attempts and smoking cessation aids. Future interventions should focus on more intensive interventions with GPs and patients.

Trial registration ClinicalTrials.gov Identifier: NCT04868474

Abstract 246 Table 1

Effect of the general practitioner (GP) training intervention on patient-reported smoking abstinence, quit attempts, and use of a smoking cessation aid at 3-weeks, 3-months, and 6-months follow-up, adjusted for clustering by GP (n=34 recruiting GPs and n=287 patients)

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