Ask-Advise-Connect

Abstract

Importance: Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance.Objective: To evaluate a new approach-Ask-Advise-Connect (AAC)-designed to address barriers to linking smokers with treatment.Design: A pair-matched, 2-treatment-arm, grouprandomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011.Setting: Ten clinics in Houston, Texas.Participants: Smoking status assessments were completed for 42 277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics.Interventions: Linking smokers with quitlinedelivered treatment.Main Outcome Measure: Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment.Results: In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t 4 = 9.19 [P Ͻ .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. Conclusions and Relevance:The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.

Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the NHS Stop Smoking Services

“…[123][124][125] Abstinence rates can vary significantly depending on which practitioner and type of practitioner was seen, and it is known that some types of intervention (group or one-to-one) are more effective than others. 126,127 Abstinence rates can also be affected by other factors, such as the dependence and deprivation level of the population served, 128 and it is likely that these factors were at least partly responsible for the variation in abstinence rates seen in this study. However, differences in organisation and service characteristics could be a more central influence on attendance following the taster session.…”

“…A more proactive approach of 'ask, advise, contact', in which smokers are contacted proactively by the service on receipt of their contact information, can reduce patient barriers to receiving treatment, and also has high potential to increase uptake. 128 The results of the adherence to the delivery of the intervention would suggest that the protocol for the taster session is appropriate. Adaptations to suit the local features and attributes could be implemented, with mechanisms to ensure that interested clients are offered early and convenient appointments with the service.…”

The Ask–Advise–Connect Approach for Smokers in a Safety Net Healthcare System

“…Importantly, AAC yielded a larger effect size in a safety-net healthcare system than a private healthcare system (30-fold vs. 13-fold increase in treatment enrollment). 25 Recent healthcare reform legislation has created an environment in which programs such as AAC could be integrated and sustained within healthcare settings. 29–31 …”

“…Results of our initial trial, conducted in a private healthcare system, indicated that AAC (vs. AAR) was associated with a 13-fold increase in treatment enrollment. 25 The current study utilized similar methodology and was intended to replicate the findings in a safety-net healthcare system.…”

A randomized trial to evaluate primary care clinician training to use the Teachable Moment Communication Process for smoking cessation counseling

“…A recent review of strategies to increase smoking cessation treatment in primary care (Papadakis et al, 2010) suggests that multi-component interventions (e.g., clinician training combined with practice-level interventions such as electronic health record reminders) hold the most promise for affecting both clinician and patient behavior leading to smoking cessation. Further, the TMCP approach could be integrated with supports to easily connect patients with additional resources for cessation, such as tobacco quit lines (Cummins et al, 2007; Vidrine et al, 2013a, 2013b) or other forms of electronic cessation assistance (Chen et al, 2012). …”