TY - JOUR
T1 - Promoting Primary Care Smoking-Cessation Support with Quitlines. The QuitLink Randomized Controlled Trial
AU - Rothemich, Stephen F.
AU - Woolf, Steven H.
AU - Johnson, Robert E.
AU - Devers, Kelly J.
AU - Flores, Sharon K.
AU - Villars, Pamela
AU - Rabius, Vance
AU - McAfee, Tim
N1 - Funding Information:
This study was funded through a grant from the Agency for Healthcare Research and Quality (Grant 5R21HS014854-02 ). The authors thank the Virginia Ambulatory Care Outcomes Research Network; the research assistants who administered the exit surveys (Melissa Johnson Becker, Deidre Henley, Ann Luck, Carolyn Mitchell); and the clinicians, staff, managers and patients of the participating practices: Ashland Medical Center, Ashland; Aylett Medical Center, Aylett; Bowles, Bowles and Short Family Physicians, Sandy Hook; Cold Harbor Family Practice, Mechanicsville; Drs. Titus, Hendrix, Turner, Pahle and Christensen, Richmond; Green Medical Center, Richmond; Huguenot Primary Care, Midlothian; Laburnum Medical Center, Richmond; Memorial Medical Center, Mechanicsville; Midlothian Family Practice, Inc.—Powhatan, Powhatan; Midlothian Family Practice, Inc.—Watercove, Midlothian; Midlothian Primary Care, Ltd., Midlothian; Powhatan Family Physicians, Powhatan; Richmond Family Practice, Richmond; Tidewater Physicians Multispeciality Group—West Point, West Point; Village Green Family Medicine, Midlothian. The authors also thank Amy Burgett, RN, for assistance with survey data collection and Paul Mazmanian, PhD, for assistance conducting interviews.
PY - 2010/4
Y1 - 2010/4
N2 - Background: Counseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work. Telephone quitlines can deliver effective intensive counseling, but few collaborate closely with clinicians. Purpose: This study aimed to determine whether cessation support in practices is enhanced by a systems approach, in partnership with quitlines. Design: A cluster RCT was used. Setting/participants: Participants included 1817 adult smokers from 16 primary care practices in the Virginia Ambulatory Care Outcomes Research Network. Intervention: An expanded tobacco-use "vital sign" intervention (identify smokers, advise cessation, and assess readiness to quit) that was combined with fax referral of preparation-stage smokers to a quitline providing feedback to practices was compared to a traditional tobacco-use vital sign alone. Main outcome measures: The frequency of cessation support (in-office discussion of methods to quit or quitline referral) reported by patients in an exit survey (September 2005-July 2006, analyzed in 2008) was measured. Results: The adjusted percentage of smokers who reported receiving cessation support differed by 12.5% in intervention and control practices (40.7% vs 28.2%, respectively; p<0.001). Both in-office discussion of methods to quit and quitline referral increased significantly with the intervention. Post hoc analysis revealed that the increase in cessation was stable for both patient gender and visit type and was more pronounced with patients aged 35-54 years and with male and more experienced clinicians. Conclusions: A systems approach to identifying smokers, advising and assessing readiness to quit, combined with a partnership with a quitline, increases delivery of cessation support for primary care patients beyond that accomplished by traditional tobacco-use vital sign screening alone. Clinical trial registration: NCT00112268.
AB - Background: Counseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work. Telephone quitlines can deliver effective intensive counseling, but few collaborate closely with clinicians. Purpose: This study aimed to determine whether cessation support in practices is enhanced by a systems approach, in partnership with quitlines. Design: A cluster RCT was used. Setting/participants: Participants included 1817 adult smokers from 16 primary care practices in the Virginia Ambulatory Care Outcomes Research Network. Intervention: An expanded tobacco-use "vital sign" intervention (identify smokers, advise cessation, and assess readiness to quit) that was combined with fax referral of preparation-stage smokers to a quitline providing feedback to practices was compared to a traditional tobacco-use vital sign alone. Main outcome measures: The frequency of cessation support (in-office discussion of methods to quit or quitline referral) reported by patients in an exit survey (September 2005-July 2006, analyzed in 2008) was measured. Results: The adjusted percentage of smokers who reported receiving cessation support differed by 12.5% in intervention and control practices (40.7% vs 28.2%, respectively; p<0.001). Both in-office discussion of methods to quit and quitline referral increased significantly with the intervention. Post hoc analysis revealed that the increase in cessation was stable for both patient gender and visit type and was more pronounced with patients aged 35-54 years and with male and more experienced clinicians. Conclusions: A systems approach to identifying smokers, advising and assessing readiness to quit, combined with a partnership with a quitline, increases delivery of cessation support for primary care patients beyond that accomplished by traditional tobacco-use vital sign screening alone. Clinical trial registration: NCT00112268.
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U2 - 10.1016/j.amepre.2010.01.008
DO - 10.1016/j.amepre.2010.01.008
M3 - Article
C2 - 20307804
AN - SCOPUS:77949461183
SN - 0749-3797
VL - 38
SP - 367
EP - 374
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 4
ER -