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Two approaches to referral for smoking cessation treatment

Institution: University of California, Los Angeles
Investigator(s): Scott Eliot Sherman, M.D., M.P.H.
Award Cycle: 2001 (Cycle 10) Grant #: 10RT-0023 Award: $496,836
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Research Project Awards

Initial Award Abstract
With nearly all managed care organizations (MCO’s) adopting quality measures relating to smoking cessation, the first goal for most MCO’s is to ensure that all patients are asked about smoking and that all smokers are counseled about quitting. Throughout the Veterans Health Administration those objectives have largely been achieved. Based on an external assessment, 96% of patients were asked about smoking within the past year, 90-95% of smokers were advised to quit, and 59% of smokers were counseled at least 3 times in the last year.

Once smokers are routinely being identified and advised to quit, the big dilemma for many MCO’s is how to assist patients in quitting. There are a wide variety of possible models but little available evidence to help an MCO choose which is likely to be the most effective and what the relative costs are. While the literature suggests that organized smoking cessation programs are the most cost-effective approach, there is little consensus on what methods are most effective for getting patients to those programs. This proposal compares usual care (smoking cessation counseling by the primary care provider, often with referral to the smoking cessation clinic) to counseling facilitated by an on-call smoking cessation counselor. The rationale for the intervention is that the availability of the on-call counselor will decrease the amount of time that the physician needs to spend counseling the patient, thereby improving the provider’s efficiency. At the same time, the on-call counselor should be more successful at getting patients into the smoking cessation programs because he or she can spend more time counseling and has more expertise in counseling.

Our main goal for the project is to determine whether the presence of an on-call counselor increases the number of people referred to a smoking cessation program. Our other goals are 1) to see whether smokers on the intervention team are more likely to quit, 2) to determine which approach is more cost-effective, and 3) to determine whether patients and providers are more satisfied with the on-call counselor approach.