| Is the implementation of a specific smoking cessation strategy for COPD patients in general practice applicable and (cost-)effective? Most patients with COPD have been smokers with a lot of packyears. Figures from recent research (Smeele, Jacobs) showed that about 36% of the COPD-patients who are treated by the general practitioner are still smoking. Smoking patients can be distinguished by their willingness to quit smoking. Most of the smoking Dutch patients can be located in the so-called precontemplative phase; they are not considering to quit smoking within the next 6 months. Despite their respiratory symptoms the smoking COPD patients have not been willing or not been able to give up smoking. Therefore we have reasons to assume that a minimal cessation strategy focused on the patient's present stage of motivation to quit smoking might be to weak to get good quitting results. Patient factors as well as care provider factors form barriers in the cessation process. For that reason we investigate a stop-smoking-strategy aimed at the two sides of the health counseling process: intensive support for the COPD patient in general practice in giving up smoking and support for the GPs and practice assistants in performing the cessation strategy effectively. Our research questions are: a) Is a specific smoking cessation protocol for COPD patients applicable in general practice? b) What is the effect of an implementation strategy using trained facilitators on the smoking behaviour of COPD-patients? c) What is the cost-effectiveness of the facilitator-based strategy to implement a smoking cessaton protocol for COPD-patients? Parts of the implementation strategy and the protocol are based upon already existing methods and materials the effectiveness of which have been investigated before. New is the combination of the elements: support for general practices in implementing and applying an intensive smoking cessation protocol for a specific category of chronic patients. |
