Quitline treatment dose predicts cessation outcomes among safety net patients linked with treatment via Ask-Advise-Connect

Abstract

The efficacy of tobacco treatment delivered by state quitlines in diverse populations is well-supported, yet little is known about associations between treatment dose and cessation outcomes following the implementation of Ask-Advise-Connect (AAC), an electronic health record-based systematic referral process that generates a high volume of proactive calls from the state quitline to smokers. The current study is a secondary analysis of a 34-month implementation trial evaluating ACC in 13 safety-net clinics in Houston, TX. Treatment was delivered by a quitline and comprised up to five proactive, telephone-delivered multi-component cognitive-behavioral treatment sessions. Associations between treatment dose and abstinence were examined. Abstinence was assessed by phone six months after treatment enrollment, and biochemically confirmed via mailed saliva cotinine. Among smokers who enrolled in treatment and agreed to follow-up (n = 3704), 29.2% completed no treatment sessions, 35.5% completed one session, 16.4% completed two sessions, and 19.0% completed ≥three sessions. Those who completed one (vs. no) sessions were no more likely to report abstinence (OR: 0.98). Those who completed two (vs. no) sessions were nearly twice as likely to report abstinence (OR: 1.83). Those who completed ≥three (vs. no) sessions were nearly four times as likely to report abstinence (OR: 3.70). Biochemically-confirmed cessation outcomes were similar. Most smokers received minimal or no treatment, and treatment dose had a large impact on abstinence. Results highlight the importance of improving engagement in evidence-based treatment protocols following enrollment. Given that motivation to quit fluctuates, systematically offering enrollment to all smokers at all visits is important.

Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

“…"Yes, I would (like to talk to the QL), because it was just a misunderstanding and the wrong (15,17,18). This study expands our understanding of why so many smokers, having Other studies have also found that stressors related to lower SES are a barrier to use of QL counseling (25,26).…”

“…They found that at the non-HIV clinics, 54.5% of referred smokers were later unreachable, and of those reached, 24% then declined services; similarly, among those seen at the HIV clinic, 55.6% of referred patients were unreachable and 24.9% of those reached declined services (15). In addition to being unreachable or declining QL participation, many smokers do not complete the multiple (3)(4)(5) counseling sessions offered by most QLs (17,18). This is signi cant because research has found that those who complete more of the calls offered in QL programs have higher quit rates than those who complete fewer calls (7,18,19).…”

“…In addition to being unreachable or declining QL participation, many smokers do not complete the multiple (3)(4)(5) counseling sessions offered by most QLs (17,18). This is signi cant because research has found that those who complete more of the calls offered in QL programs have higher quit rates than those who complete fewer calls (7,18,19).…”

Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

“…Electronic referrals to QLs are recommended by the Community Preventive Services Task Force as an effective intervention for increasing tobacco cessation among patients interested in quitting [23], however, rates of QL program completion are poor [15,17,18]. This study expands our understanding of why so many smokers, having accepted a referral during their primary care office visit, later disengage with the QL.…”

Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

“…Bui et al found that 54.5% of eReferred smokers were later unreachable, and of those reached, 24% then declined services (15). In addition to being unreachable or declining QL participation, many smokers do not complete the multiple (3)(4)(5) counseling sessions offered by most QLs (17,18). This is significant because research has found that those who complete more of the calls offered in QL programs have higher quit rates than those who complete fewer calls (7,18,19).…”