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 midintervention (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.
This study compares the effectiveness and tolerability of bupropion versus bupropion plus nicotine patch for smoking cessation in a routine clinical setting. Patients at the Sepulveda Veterans Health Administration Smoking Cessation Clinic completed a baseline survey and received counseling over 2 months, along with bupropion or bupropion plus nicotine patch. Of the 227 patients randomized to treatment, 112 (49%) received bupropion only and 115 (51%) received the combination therapy. At least one side effect was noted in 55% of bupropion patients and 70% of combination therapy patients; treatment regimens were changed in 7% and 14%, respectively. Abstinence rates at 2 months were 26% for the bupropion group and 37% for the combination therapy group (p = 0.1), and at 6 months were 42% versus 35%, respectively (p = 0.4). Although 6-month abstinence rates were derived from patient self-report and should be interpreted with caution, these results suggest that most patients referred to the clinic are able to take these medications. There was no difference in the rate of switching treatments, or in long-term abstinence rates.
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