Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1035 — Promoting Repeat Treatment Among Relapsed Smokers: Results from a Randomized Controlled Trial

Author List:
Partin MR (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
An LC (University of Minnesota)
Nelson DB (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Nugent S (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Synder A (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Fu SS (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Willenbring M (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)
Joseph AM (Center for Chronic Disease Outcomes Research, Minneapolis VAMC)

Objectives:
To assess the effectiveness of a systems intervention for increasing repeat tobacco dependence treatment in a population of relapsed smokers.

Methods:
The study was a multi-center randomized controlled trial. Veterans age 19 and older receiving a prescription for nicotine replacement therapy or bupropion for smoking cessation in 2002 at one of five participating VHA facilities were eligible for the study. 1,900 eligible veterans were randomized to: (1) patient phone call to assess smoking status, quit challenges, and treatment preferences, and computerized progress note to providers communicating this information (intervention), or (2) usual care (control). The primary outcome was the proportion of patients receiving pharmacological or other smoking cessation treatment in the 6 month follow-up period, as assessed from VA pharmacy and outpatient data files. Additional outcomes assessed by patient phone survey included 7 day point prevalence abstinence and satisfaction.

Results:
34% of intervention participants versus 22% of control participants received treatment for tobacco dependence in the follow-up period (OR 1.79; 95% CI 1.46-2.19). 32% of intervention participants versus 21% of controls received pharmacological treatment for tobacco dependence in the follow-up period (OR 1.78, 95% CI 1.45-2.20), and 12% of intervention subjects versus 8% of controls received behavioral treatment (OR 1.56, 95% CI 1.14-2.12). The survey response rate was 84%. Abstinence rates at follow-up were 26% for intervention subjects and 21% for controls (OR 1.18, 95% CI 0.94-1.49). Intervention subjects were more likely than controls to report being satisfied with the general smoking cessation help they received from the VA (87 versus 82%, OR=1.44, 95% CI 1.08-1.95) as well as the pharmacological help they received from the VA (89 versus 84%, OR = 1.50, 95% CI 1.09-2.07).

Implications:
The intervention significantly increased tobacco dependence treatment rates and satisfaction relative to usual care.

Impacts:
Improvements in smoking cessation treatment rates can be achieved in the VA by implementing this relatively simple systems intervention designed to target a population of responsive smokers and link them with effective smoking cessation treatments.