Telephone Care Coordination for Smokers in Mental Health Clinics
Scott E. Sherman MD MPH
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
New York, NY
Funding Period: October 2008 - September 2013

BACKGROUND/RATIONALE:
Smoking is the leading preventable cause of death in the US and is a particular problem among VA users and persons with a diagnosed mental illness. Telephone counseling represents the most feasible approach to increasing smoking cessation treatment among VA mental health patients. This study will implement a smoking cessation telephone care coordination program for patients in mental health clinics.

OBJECTIVE(S):
(1) Evaluate the process of adapting, implementing, and sustaining a smoking cessation telephone care coordination program in Mental Health Clinics; (2) Determine the effectiveness of telephone counseling in promoting long-term abstinence from smoking among mental health patients; and (3) Compare the effectiveness of telephone counseling delivered by VA staff with that delivered by state Quitlines.

METHODS:
The telephone care coordination program involves the following steps: (1) brief counseling from mental health provider and referral to treatment through CPRS; (2) prescribing and mailing of smoking cessation medications by a Care Coordinator; (3) proactive multi-call counseling from either a VA Care Coordinator or state Quitline for 2 months; and (4) follow-up at 2 and 6 months to check patient's smoking status. We will implement the program at six VA facilities.

We anticipate receiving approximately 10,750 referrals to the program and approximately 5,375 veterans will enroll. Of these, 2,688 will be allocated to receive counseling from VA staff and the same number will receive counseling from their state Quitline.

We will have two primary outcomes: the long-term abstinence rate (as measured by 30-day point prevalence abstinence at 6 months) and the rate of program adoption by mental health providers and patients. Secondary outcomes will include: (1) 30-day point prevalence abstinence rate at 2-months; (2) quit attempt rate; (3) rate of use of smoking cessation medications; and (4) site-level performance rates on the VA tobacco performance measures (whether smokers were offered counseling, referral, and medications).

We will conduct a formative evaluation throughout the study answer target implementation questions and help interpret primary outcome findings. The entire study will take 4 years to complete.

FINDINGS/RESULTS:
Findings are preliminary. We have received significantly fewer referrals than expected, and efforts to increase the use of the smoking cessation program by Mental Health providers have had limited success. We received 1207 referrals by 3/1/2012. We were able to reach approximately 78% of patients referred, and approximately 70% of them enrolled in treatment. Of those who enroll in treatment, almost 90% are interested in using smoking cessation medications and 100% schedule an appointment for counseling. Current long-term abstinence rates are comparable to those seen in non-mental health populations.

IMPACT:
On average, 5% of all smokers who use VA Mental Health services were referred to the program. Among patients referred and who enrolled in counseling, 20% were abstinent 6 months later. The TelequitMH program had lower reach, yet higher effectiveness, than anticipated.

PUBLICATIONS:
None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Treatment - Observational
Keywords: QUERI Implementation, Smoking, Telemedicine
MeSH Terms: none