VCU Study: Collaboration Between Primary Care Physicians and Telephone Quitlines More Likely to Help Smokers Quit

By Sathya Achia Abraham

When it comes to helping smokers kick the habit, primary care practices that employ a telephone quitline are better able to help their patients, according to a study conducted by Virginia Commonwealth University and the Virginia Ambulatory Care Outcomes Research Network.

Although telephone quitlines have been found to be effective for counseling and helping smokers quit, relatively few are offered in collaboration with clinicians.

In a study published in the April 2010 issue of the American Journal of Preventive Medicine, the VCU group found that practices with a quitline provided help quitting to 41 percent of smokers who came to the office, compared to only 28 percent of smokers in practices that did not have a referral system in place.

“Practices that used a systematic process to ask about smoking, advise tobacco cessation, and assess interest in quitting, along with a fax mechanism to refer interested patients to a quitline were more likely to provide support to help smokers quit, compared to practices that did not have such a system for assessment and referral,” said corresponding author of the study, Stephen Rothemich, M.D., co-director of the Virginia Ambulatory Care Outcomes Research Network in the VCU Department of Family Medicine, or ACORN.

Fifty medical practices throughout the state participate in ACORN. Led by Rothemich and Daniel Longo, Sc.D., ACORN is part of a nationwide group of “PBRNs,” or practice-based research networks that serve as real-time research laboratories for studying how to better provide primary care.

ACORN tracks important trends and patterns in the health status of primary care patients and performs studies to test whether interventions by patients, providers or health systems are effective in improving the quality or outcomes of care.

In a previously published 2006 study, Rothemich and colleagues had found that practices that considered smoking status a ‘vital sign,’ and asked patients about tobacco use at every visit were more likely to advise smokers to quit than practices that did not do this, but they were no more likely to go further and provide assistance in quitting.

“In the current study we wanted to see if working with quitlines could help practices provide more assistance to smokers, since most practices find it difficult to provide this more intensive help at busy office visits,” explained Rothemich.

Through a randomized controlled trial the team surveyed 1,817 adult smokers from 16 participating practices. Clinicians used an enhanced vital sign intervention to identify smokers, advise cessation and assess their readiness to quit, as well as a mechanism to refer patients to a quitline by fax. This was compared to the use of a traditional tobacco use vital sign alone.

The work was supported through a grant from the Agency for Healthcare Research and Quality.