Sherman SE (COE Sepulveda), Cummins S
(Univ of California San Diego), York LS
(COE Sepulveda), Finney J
(VA Palo Alto HCS), Kalra P
(VA Palo Alto HCS), Kuschner W
(VA Palo Alto HCS), Guvenc-Tuncturk S
(VA Palo Alto HCS), Zhu SH
(Univ of California San Diego)
Telephone counseling is effective but seldom used within health care. Patients rarely follow through with referrals to telephone programs. We evaluated the effectiveness of four approaches to telephone care coordination for smoking cessation.
We included 35 sites in a Veterans Health Administration (VA) group randomized trial of telephone care coordination (TeleQuit). Providers were responsible for initial brief smoking cessation counseling and for referring smokers to TeleQuit through two additional clicks in the electronic medical record. All patients enrolling in TeleQuit received medications and self-help materials. We randomly assigned referral weeks to different approaches to patient contact – either proactive (we called the patient) or reactive (we mailed materials and waited for the patient to call). In addition, we randomly assigned sites to either multi-session counseling from the California Smokers’ Helpline (quitline) or self-help materials only. At 6-7 months, we called all referred patients (whether enrolled or not) to assess self-reported smoking status.
Over 18 months, we received 6,118 referrals. Proactive contact patients were more likely to enroll in the program (1,725/3,035 = 57%) than reactive contact patients (987/3,083 = 32%) (OR 2.8, 95% CI 2.5-3.1). Self-help patients were more likely to enroll (1,073/2,257 = 48%) than quitline patients (1,639/3,861 = 42%) (OR 1.2, 95% CI 1.1-1.4). Of the 2,369 patients who had reached 6 month follow-up, 210 had moved and 24 died prior to evaluation. Of the remaining subjects, we were able to evaluate 1,495 subjects (70%), of whom 310 were abstinent (21%). Abstinence rates were comparable across groups – proactive self-help, 20%; proactive quitline, 25%; reactive self-help, 15%; reactive quitline, 22%.
Proactive contact dramatically increases participation in cessation services. Long-term abstinence rates were excellent in all four groups, although this preliminary follow-up analysis did not have the power to compare abstinence rates between groups.
Telephone care coordination is a very promising approach to help smokers quit.