Three main approaches exist to help primary care patients quit smoking – primary care-based treatment, smoking cessation program referral, and referral to telephone counseling (Quitline). We tested the effectiveness of a system to increase Quitline referrals.
We randomly allocated 10/18 Veterans Administration (VA) sites in California to receive the Telephone Care Coordination Program, which included simple (“2-click”) referral, proactive care coordination, medication management (transdermal nicotine and/or bupropion), and follow-up (2, 4, 6, and 8 weeks; 6 months). The VA care coordinator initiated a 3-way call to the California Smokers’ Helpline, which subsequently provided a standard 30-45 minute counseling call. At baseline and the end of the 10-month intervention, we asked providers how many patients they had referred to telephone counseling within the last month.
In 10 months, we received 2,965 referrals. We were unable to reach 1,156 (39%) despite 3+ attempts. We excluded 73 patients (2%) and 391 (13%) were not interested in quitting. We connected the remaining 1,345 (45%) patients to the Helpline. At 6-month follow-up, 335 patients (25%) were abstinent (30-day point prevalence). When we compared the change in average number of reported telephone counseling referrals from baseline to the end of the study, there was a large increase among intervention site providers (baseline – 1.5/month, follow-up – 15.7/month) and no change at control sites (baseline – 2.2/month, follow-up – 1.0/month) (p=0.01).
The Telephone Care Coordination Program generated a large number of referrals from primary care, nearly half of whom were connected with the Helpline. Providers at intervention sites reported referring many more patients to telephone counseling than providers at control sites. Long-term abstinence among patients referred was excellent (25% at 6 months).