Sherman SE (COE Sepulveda), Cummins S
(UCSD), Finney J
(VA Palo Alto HCS), Kalra P
(VA Palo Alto HCS), Kuschner W
(VA Palo Alto HCS), York LS
(COE Sepulveda), Zhu SH
Telephone counseling is effective but seldom used within health care. Patients rarely follow through with referrals to telephone programs. We evaluated the effectiveness of direct transfer of VA patients to a quitline by a telephone care coordination program.
We included 35 sites in a VA group-randomized trial of telephone care coordination (TeleQuit). Providers referred smokers to TeleQuit through a CPRS consult. All enrolled patients received medications and self-help materials. Patients were randomized to either proactive contact (we called the patient) or reactive contact (the patient had to call us). Some patients were randomly assigned counseling from the California Smokers’ Helpline (quitline). Patients were transferred directly to the quitline during enrollment. The quitline provided up to 6 counseling sessions (1 planning session and 1-5 follow-up sessions) over 1-2 months. We contacted patients at 6 months to assess smoking status.
Over 18 months, 1,168 patients enrolled in the quitline treatment group. Of these, 1,040 (89%) agreed to be transferred to the quitline. Of these, 684 (66%) were proactive contact patients and 356 (34%) were reactive contact patients. Proactive and reactive contact patients were equally likely to complete at least one follow-up call (77% vs. 79%). Twelve percent were < = 44 years old, 74% were 45-64 years old, and 14% were > = 65 years old. The majority (62%) were white, 20% were African-American, 8% were Hispanic, and 7% were Asian or Pacific Islander. Most (68%) had at least some college. Proactive and reactive groups were equally likely to cease counseling after the planning session (23% vs. 21%). Patients completed a median of 2 follow-up calls. Abstinence rates at 6 months were 23% for proactive patients (67/290) compared to 12% of reactive patients (28/243).
Most patients were willing to complete at least one counseling session, and half completed 2 or more follow-ups. These results suggest that telephone counseling is acceptable to most VA patients who want to quit smoking. A proactive contact approach was very successful in engaging patients in counseling, and at follow-up, proactive contact patients were more likely than reactive contact patients to be tobacco-free.
Using a direct transfer to connect VA patients to a quitline is a promising approach to engaging patients in smoking cessation telephone counseling.