title: General practice counseling for patients with chronic obstructive pulmonary disease to quit smoking: impact after 1 year of two complex interventions.
abstract: OBJECTIVE
  To evaluate two counseling programs in general practice to help smokers with chronic obstructive pulmonary disease (COPD) to quit smoking.
  
  
  METHODS
  Cluster randomized controlled trial including 68 general practices (667 patients) using a randomly assigned intervention program with counseling and advice about nicotine replacement therapy (and additional bupropion-SR in one of the programs) or usual care. Usual care consisted of periodic regular check-ups and COPD information. The main outcome measure was biochemically verified point prevalence at 12 months.
  
  
  RESULTS
  The two intervention groups were treated as one in the analysis because they were equally effective. The intervention resulted in a significantly self-reported higher success rate (14.5%) compared to usual care (7.4%); odds ratio=2.1, 95% confidence interval=1.1-4.1. Biochemically verified quit rates were 7.5% (intervention) and 3.4% (usual care); odds ratio=2.3, 95% confidence interval=0.9-6.0.
  
  
  CONCLUSIONS
  The program doubled the cessation rates (statistically nonsignificant). Too few participants used the additional bupropion-SR to prove its effectiveness.
  
  
  CONCLUSIONS
  The protocols can be used for COPD patients in general practice, but expectations should be modest. If quitting is unsuccessful, a stepped care approach should be considered.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.r.hilberink@hetnet.nl
authors.forename: Sander R
authors.initials: SR
authors.lastname: Hilberink
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Jacobs
authors.forename: Marinus H M
authors.initials: MH
authors.lastname: Breteler
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003376:Counseling; D005260:Female; D058006:General Practice / Q000458:organization & administration; D058005:General Practitioners / Q000193:education; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage; D018722:Nicotinic Agonists / Q000008:administration & dosage; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D012907:Smoking / Q000009:adverse effects / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013997:Time Factors
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine