The 13th World Conference on Tobacco OR Health

Objective: Counseling by clinicians promotes smoking cessation, but routinely providing more than brief advice is difficult in most U.S. primary care practices. Barriers include competing demands and inadequate office support systems. Telephone quit lines, whose staff deliver more effective intensive counseling, are proliferating in the U.S., but few work closely with clinicians to provide feedback or forward requests for cessation medications. Whether such a partnership improves outcomes has not been studied. We present an ongoing cluster-randomized trial (ClinicalTrials.gov #NCT00112268) of such an intervention.

Methods: After assessing baseline counseling rates for 3 months, 8 of 16 primary care practices in metropolitan Richmond, Virginia were randomized to the intervention. The 9-month intervention combines: (1) an expanded “vital sign” screening; (2) fax referral of smokers to the American Cancer Society quit line; and (3) quit line feedback to providers, including progress reports and prescription requests. The primary outcome is the frequency of intensive counseling (more than brief advice to quit), reported by patients in exit surveys. The projected sample is 3200 smokers. The study includes a qualitative component with interviews of patients and practice staff about the intervention.

Results: Within the first 10 weeks of the intervention, intervention practices referred 162 smokers for telephone counseling. Exit surveys from this period suggest that the intervention is producing a significant increase in intensive counseling, although data collection must be completed to achieve adequate statistical power and assess sustainability. Details of the QuitLink system and the first 6 months of trial results will be presented.