Introduction:
The Ask-Advise-Connect (AAC) approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The aim of this study was to investigate the influence of an implementation strategy on the delivery of AAC for smoking cessation within Dutch general practice during the COVID-19 pandemic.

Material and Methods:
A nine-month pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers. During the first three months participants delivered smoking cessation care as usual; the implementation strategy came into effect after three months and consisted of two meetings in which participants were educated about AAC, made agreements on the implementation of AAC and reflected on these agreements. The changes in the proportions of ‘Ask’ and ‘Advise’ over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling.

Results:
Participants provided consultations to 29,112 patients (both smokers and non-smokers). The proportion of patients that were asked about smoking (‘Ask’) significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit (‘Advise’). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling (‘Connect’) post-intervention.

Conclusions:
The findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice.