Journal of General Internal Medicine. 2007 Aug;22(8):1125-31. Epub 2007 May 25.
Sherman SE, Estrada M, Lanto AB, Farmer MM, Aldana I.
VA Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA. scott.sherman@va.gov
Significance:
Although tobacco use is the leading preventable cause of death in the United States, physicians face many other competing demands for their time.
We tested the effectiveness of having access to an “on call” counselor, who would see the patient immediately after the physician and provide 10-15 minutes of additional smoking cessation counseling and care coordination.
During the intervention, patients on the intervention team were more likely to report being counseled about smoking, referred for additional treatment and offered smoking cessation medications. Although our sample size was not large enough to show a difference in quit rates, this easily reproducible intervention clearly improved the quality of care for smoking cessation.
Abstract:
BACKGROUND: Smoking cessation programs are very effective, but little is known about how to get smokers to attend these programs.
OBJECTIVE: To evaluate whether an "on-call" counselor increased smoking cessation program referrals and attendance.
DESIGN: We randomly assigned 1 of 2 primary care teams at the Sepulveda VA Ambulatory Care Center to intervention and the other to usual care. The intervention team had access to an on-call counselor who provided counseling and care coordination. Social marketing efforts included educational outreach, provider feedback, and financial incentives.
MEASUREMENTS: Baseline telephone interviews with a sample of 482 smokers were conducted, covering smoking history, health status, and smoking cessation treatments. Follow-up surveys were conducted at mid-intervention (n = 251) and post-intervention (n = 251).
RESULTS: Two hundred ninety-six patients were referred to the on-call counselor, who counseled each patient in person and provided follow-up calls. The counselor referred 45% to the on-site program, and 27% to telephone counseling; of these, half followed through on the referral; 28% declined referral. Patients on the intervention team were more likely to report being counseled about smoking (68% vs 56%; odds ratio [OR] 1.7, CI 1.0-2.9) and referred to a cessation program (38% vs 23%; OR 2.1, CI 1.2-3.6); having attended the program (11% vs 4%; OR 3.6, CI 1.2-10.5); and receiving a prescription for bupropion (17% vs 8%) (OR 2.3, CI 1.1-5.1). The effect was not sustained after the case management period.
CONCLUSIONS: Having access to an on-call counselor with case management increased rates of smoking cessation counseling, referral, and treatment. The intervention could be reproduced by other health care systems.
PMID: 17530311
