BACKGROUND: There are major challenges in the accessibility of effective smoking cessation support for disadvantaged groups. Implementing a smoking cessation specialist in the general practice to whom general practitioners (GPs) and general practice nurses (GPNs) refer may contribute to overcoming these challenges. However, there is lack of supporting evidence. The aim of this study is to evaluate a pilot of a smoking cessation specialist in general practice in the Netherlands.
METHODS: The process evaluation was conducted in two general practices located in disadvantaged neighborhoods, using qualitative (i.e., interviews with GPs (N=11), GPNs (N=10), a smoking cessation specialist (N=1), patients (N=11), a health insurer (N=1)) and quantitative data (i.e., demographic questionnaire and records of (N=93) patients) across the RE-AIM framework dimensions (i.e., Reach, Effectiveness, Adoption, Implementation, Maintenance). Qualitative data were analyzed thematically and quantitative data were analyzed descriptively.
RESULTS: GPs and GPNs referred patients to the smoking cessation specialist, due to the specialist’ expertise and the opportunity to outsource work. The specialist’s physical presence in the practice facilitated the implementation. GPs and GPNs did not all/always refer patients, due to not being aware of the specialist’s presence or patients not wanting to quit. In total, 93 of the 115 referred patients received smoking cessation support, consisting of disadvantaged people (e.g. 42% had difficulty making ends meet). The quit success rate was 47.7% at three months and 43.7% at six months. The person-centered approach and trusted relationship with the specialist were experienced as contributing factors for success. Implementation barriers included a complex referral procedure, a high workload of the specialist and a challenging patient group.
CONCLUSIONS: Implementing a smoking cessation specialist in general practice may improve access to smoking cessation support and quit success in disadvantaged groups. However, for sustainable implementation various barriers need to be tackled.