Introduction:
To report on the effectiveness of the ‘TiTAN Crete – Tobacco Treatment Training Network’ intervention program in influencing general practitioner’s (GP) knowledge, attitudes, self-efficacy and rates of 4As (ask, advice, assist, arrange) tobacco dependence treatment delivery.

Material and Methods:
A before-after evaluation design was used. The TiTAN Crete intervention included one core training and two booster sessions as well as the dissemination of practice and patient tools to support 4As treatment into clinical routines among a sample of GPs on the islands of Crete in Greece (2015-2016). Participating GPs (n=14), and a cross-sectional sample of patients from their practices (n=984), were surveyed before-and-after the implementation of the intervention program. Multi-level modeling was used to examine the effects of the intervention.

Results:
High rate of satisfaction were documented, with the majority of general practitioners indicating the training session met their expectations to a “great extent”. Significant increases were documented in six of the thirteen tobacco treatment knowledge areas assessed between the pre and post assessment. A significant increase in GPs self-efficacy was documented between the pre and post assessment (12.5% vs. 64.3%; p=0.016). Rates of delivery of the 4As increased significantly following program implementation (ask: 58.0% vs. 82.8%, p=0.001; advise: 52.5% vs. 81.5%, p<0.001; Assist: 16.1% vs. 64.8%, p<0.001; Arrange: 4.1% vs. 15.2%, p=0.017) at the index visit.

Conclusions:
The TiTAN Crete intervention was associated with significant increases in GP’s knowledge and attitudes regarding evidence-based tobacco dependence treatment as well as rates of tobacco treatment delivery.

Funding:
This work was supported by Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment and Pfizer Independent Grants for Learning and Change (GB-13522581).