Strengthening the Dutch national smoking cessation infrastructure to support the Smokefree Generation movement

We aim to strengthen the national Dutch stop-smoking infrastructure in an effort to increase the impact of the Smokefree Generation movement initiated by the Alliance for a Smoke-free Society (ANR) and supported by the Ministry of Health. Evidence-based smoking cessation methods are currently underused by Dutch smokers. The main bottleneck is the low referral by general practitioners (GPs) to cessation support for smokers who need this. We will develop an implementation strategy in close cooperation with GPs and practice nurses, which will result in larger numbers of smokers using evidence-based smoking cessation support. The strategy relies on exploiting existing support structures of GP offices and improving linkages between the GP practice and referral options. In line with the current clinical guidelines, the general practitioner does not have to provide counseling him- or herself, but may refer to specialised treatment according to the Ask, Advise, Connect principle. We will make the GPs’ task regarding smoking cessation easier and more practical and will fully utilize existing successful implementation support structures of general practices, including www.thuisarts.nl and the Pharmacotherapeutic Consultation Platform (PTAM) of the IVM. The GP office will be further relieved by an improved linking practice with concrete referral possibilities in the GP practice’s own region, building on the already existing ‘social map’ of smoking cessation counselling by the Trimbos Institute. These activities will result in improved local care paths. We will conduct an implementation study focusing on the development, refinement, and testing of the proposed implementation strategy in GP offices, leading to recommendations for nation-wide implementation. The implementation strategy will be tested in 24 groups of GP practices, using a stepped-wedged cluster randomized design. The main outcome measure is the increase in the number of smoking patients who are connected to efficacious smoking cessation support. Based on the results, budget-impact and cost-effectiveness estimates will be calculated of the population impact to be achieved in a national roll-out.