National scale-up of the TITAN Greece and Cyprus Primary Care Tobacco Treatment Training Network: Efficacy, assets, and lessons learned

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A recent conference proceeding, representing the Cyprus team on the TITAN project.


European Tobacco Treatment guidelines recommend that all primary care providers be prepared to deliver evidence-based treatment to address tobacco use in their patients.

The TiTAN Greece and Cyprus Project aim was to support and evaluate the national scale-up of a training-based intervention and clinical tools for tobacco treatment among primary care practitioners (PCPs) in Greece and Cyprus.

A pre-post evaluation was conducted with measurement occurring before, immediately following and at 6 months following exposure to the training intervention. All PCPs in five geographical regions in Greece (Crete, Athens, Thessaloniki, Ioannina, Kerkira) and Nicosia (Cyprus) were invited to participate in partnership with the regions medical school and local health authority. Participating PHC were exposed to a 1-day training program, a 3-hour booster training session, and toolkit to assist with integrating evidencebased tobacco treatments into their clinical practice routines.

A total of 300 people (58% of eligible PCPs) participated in the training intervention. Ηigh-levels of satisfaction were reported for the training-curricula, speakers, and clinical tools. Significant increases in PCPs’ knowledge, self-efficacy, intentions, and rates of tobacco treatment delivery (5As) were documented following exposure to the intervention. Pre-post rates of tobacco treatment were: Ask, pre 76.7% vs post 86.9% (p=0.02); Advise, pre 53.2% vs post 76.0% (p<0.001); Assess, pre 48.5% vs post 59.7% (p=0.03); Assist, pre 27.8% vs post 56.2% (p<0.001); and Arrange, pre 22.4% vs post 53.3% (p<0.001). Among the 47 PCPs who reported current smoking at baseline, 31.9% reported they quit smoking at the follow-up at 6 months.

The TITAN Greece and Cyprus training program, toolkit and dissemination model used was very well received by the PCP community and was effective in increasing rates of tobacco treatment delivery. Sustaining such training networks is warranted and requires further attention. Lessons learned and training assets may be of value for other European countries.


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