3027 — Preliminary Results from a Study of Telephone Care Coordination for Smoking Cessation

Sherman SE (VA New York Harbor Healthcare System), Cummins S (University of California at San Diego), Finney J (VA Palo Alto Healthcare System), Kalra P (VA Palo Alto Healthcare System), Kuschner W (VA Palo Alto Healthcare System), York LS (VA Greater Los Angeles Healthcare System), Zhu S (University of California at San Diego)

Objectives:
Telephone counseling is effective but seldom used within health care. Patients rarely follow through with referrals to telephone programs. We evaluated the effectiveness of four approaches to telephone care coordination for smoking cessation.

Methods:
These data are preliminary results from 12 Los Angeles sites participating in TeleQuit, a 60-site Veterans Health Administration (VA) group randomized trial of telephone care coordination. Providers were responsible for initial brief smoking cessation counseling and for referring smokers to TeleQuit through two additional clicks in the electronic medical record. All patients enrolling in TeleQuit received medications and self-help materials. We randomly assigned referral weeks to different approaches to patient contact – either proactive (we called the patient) or reactive (we mailed materials and waited for the patient to call). In addition, we randomly assigned sites to either multi-session counseling from the California Smokers’ Helpline (quitline) or self-help materials only. At 12-18 months, we called all referred patients to assess self-reported smoking status.

Results:
Over 8 months, we received 1,326 referrals. Follow-up was pending for 154 subjects, 153 had moved and 44 died prior to evaluation. Of the remaining subjects, we were able to evaluate 706 (63%). Compared to reactive contact, proactive contact patients were more likely to enroll in the program (68% vs. 27%, OR 5.5, 95% CI 3.9-7.7). Among patients assigned to the quitline, abstinence rates were higher for patients enrolled in TeleQuit than for those not enrolled (27% vs. 15%, OR 2.1, 95% CI 1.2-3.5). Among patients assigned to self-help, TeleQuit enrollment status made no difference (19% vs. 23%, OR 0.8, 95% CI 0.4-1.4). At evaluation, 153 subjects were abstinent (22%), and abstinence rates were comparable across groups – proactive self-help, 19%; proactive quitline, 23%; reactive self-help, 24%; reactive quitline, 21%.

Implications:
Proactive contact dramatically increases participation in cessation services. Long-term abstinence rates were excellent in all four groups, although this preliminary analysis did not have the power to compare abstinence rates between group.

Impacts:
Telephone care coordination is a very promising approach to help smokers quit.