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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Friday, July 14, 2006 - 4:00 PM

Does triage improve cessation outcomes relative to self selection of treatment? Results of a randomized trial

Paul W. McDonald, PhD1, Lisa Shaffer2, Philip Smith, PhD3, Lorraine Begley, MEd.3, Stephanie Filsinger, MSc1, Rashid Ahmed, PhD, (cand)1, and Matt Grey, BSc1. (1) Department of Health Studies and Gerontology/Population Health Research Group, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 3G1, Canada, (2) Public Health Policy, Prince Edward Island Department of Health and Human Services, P.O. Box 2000, 16 Garfield St., Charlottetown, PE C1A 7N8, Canada, (3) Department of Psychology, University of Prince Edward Island, 550 University Ave., Charlottetown, PE C1A 4P3, Canada

Objective: Many communities offer multiple types of smoking cessation treatments. Smokers may be confused about which ones to use. Providers may be confused about when to treat and when to refer. This study tested a simple triage tool to help match smokers to appropriate treatment.

Methods: Motivated adult smokers in PEI, Canada were recruited through telemarketing and assigned randomly to receive either a list of all cessation treatments in the region (self selection condition), or a recommendation to use a specific treatment (self help booklet, brief telephone counseling, brief telephone counseling plus 4 weeks of NRT, 4 sessions of face to face counseling plus 4 weeks of NRT) as determined by simple triage tool (triage condition). Abstinence, treatment utilization, and user satisfaction were assessed by telephone 7 months after enrolment.

Results: 1486 participants were similar across treatment conditions (53% female; 48% >age 44; mean of 19 cpd). 82% completed the 7 month follow-up. Within the triage condition, 19%, 12%, 56% and 13 % of smokers were assigned to receive self help, brief counseling, brief counseling + NRT, intense counseling + NRT respectively. Quit rates and user satisfaction did not differ across conditions. However, self referral resulted in use of more intense treatments, and ineffective/alternative treatments (e.g., hypnosis, laser), all of which increased the cost per quitter.

Implications: Use of a simple, 8 item tool to triage smokers into treatment has the potential to improve the cost effectiveness of treatment without reducing overall effectiveness or user satisfaction.

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