Increasing Referrals to Telephone Counseling for Smoking Cessation

Sherman SE, Takahashi NY, Kalra P, Kuschner W, Canfield J, Gifford E, Kelly J, Finney J. Increasing Referrals to Telephone Counseling for Smoking Cessation. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.

Objectives: Despite widespread availability of free Quitlines, proven Quitline effectiveness, and scarce institutional resources for counseling, few healthcare organizations refer patients to Quitlines for smoking cessation. We tested the effectiveness of a telephone care coordination program (TCCP) for smoking cessation, whose objective was to increase referrals to the state Quitline and to provide smoking cessation medication management.Methods: We randomly assigned 10/18 sites in 2 California VA healthcare systems to TCCP, which included assistance in contacting the state Quitline and provision and monitoring of medications. Our outcome measures were the number of patients starting treatment and the number who completed the 2-month program and were abstinent from cigarettes.Results: At baseline, providers reported essentially never referring patients for telephone counseling (median 0 referrals/month). During the first three months, TCCP received 812 referrals. We were unable to reach 359 patients (44%) despite multiple attempts and 119 patients (15%) opted not to start. Of the remaining 334 patients (41%) who began the telephone cessation program, 17% never completed initial Quitline contact, 29% dropped out of the program, 34% were still in progress and 20% successfully completed TCCP. 41% of patients who started medications and are not still in progress successfully completed TCCP.Conclusions: The TCCP dramatically increased use of the state Quitline. 20% successfully completed the 2-month program.Impact: This program provides an effective method to increase referrals to telephone counseling and coordinate smoking cessation medications. This gives VA medical centers another option, increasing access to smoking cessation treatment without overwhelming primary care providers.