Effectiveness of an On-Call Counselor at Increasing Smoking Treatment

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 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.

Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record

“…Moreover, some studies do not even report such outcomes as the offer of treatment (e.g., [50]). Further, the complexity and costs of the health care system changes differ greatly with some involving multi-component interventions (e.g., comprising an on-call counselor, free medication, staff training, academic detailing and so on; [51]) and some only provision of a stamp to encourage smoker identification [52].…”

Integrating tobacco treatment into thoracic oncology settings: Lessons learned

“…Self-reported smoking status was assessed at each counseling session. Social support was measured at baseline and follow-up using four items from the emotional/informational scale of the Medical Outcomes Study social support survey (Kornblith, Dowell, Herndon et al, 2006; Naughton, Herndon, Shumaker et al, 2002; Queenan, Feldman-Stewart, Brundage et al, 2010; Sherman, Estrada, Lanto et al, 2007). Depression and anxiety symptoms were measured at baseline and follow-up via the Hospital Anxiety and Depression Scale (HADS), a 14-item assessment of mood with depression and anxiety subscales (Zigmond & Snaith, 1983).…”

Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models

“…In this model, the primary care provider does initial brief counselling and then refers smokers to a telephone counselling programme. Unfortunately, even if adopted consistently, few smokers follow through with referrals and may need assistance in being connected with counselling 9. More effective strategies are needed to engage patients in external counselling.…”