Offering Population-Based Tobacco Treatment in a Healthcare Setting

• Published in: American journal of preventive medicine 2011, Vol.41 (5), p.498-503
• Main Authors: Rigotti, Nancy A., MD, Bitton, Asaf, MD, MPH, Kelley, Jennifer K., MA, RN, Hoeppner, Bettina B., PhD, Levy, Douglas E., PhD, Mort, Elizabeth, MD, MPH
• Format: Article
• Language: English
• Subjects: Internal Medicine
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2011.07.022

Background The healthcare system is a key channel for delivering treatment to tobacco users. Brief clinic-based interventions are effective but not reliably offered. Population management strategies might improve tobacco treatment delivery in a healthcare system. Purpose To test the effectiveness of supplementing clinic-based care with a population-based direct-to-smoker (DTS) outreach offering easily accessible free tobacco treatment. Design Randomized controlled trial, conducted in 2009–2010, comparing usual clinical care to usual care plus DTS outreach. Setting/participants A total of 590 smokers registered for primary care at a community health center in Revere MA. Interventions Three monthly letters offering a free telephone consultation with a tobacco coordinator who provided free treatment including up to 8 weeks of nicotine patches (NRT) and proactive referral to the state quitline for multisession counseling. Main outcome measures Use of any tobacco treatment (primary outcome) and tobacco abstinence at the 3-month follow-up; cost per quit. Results Of 413 eligible smokers, 43 (10.4%) in the DTS group accepted the treatment offer; 42 (98%) requested NRT and 30 (70%) requested counseling. In intention-to-treat analyses adjusted by logistic regression for age, gender, race, insurance, diabetes, and coronary heart disease, a higher proportion of the DTS group, compared to controls, had used NRT (11.6% vs 3.9%, OR=3.47; 95% CI=1.52, 7.92) or any tobacco treatment (14.5% vs 7.3%, OR=1.95, 95% CI=1.04, 3.65) and reported being tobacco abstinent for the past 7 days (5.3% vs 1.1%, OR=5.35, 95% CI=1.23, 22.32) and past 30 days (4.1% vs 0.6%, OR=8.25, 95% CI=1.08, 63.01). The intervention did not increase smokers' use of counseling (1.7% vs 1.1%) or non-NRT medication (3.6% vs 3.9%). Estimated incremental cost per quit was $464. Conclusions A population-based outreach offering free tobacco treatment to smokers in a health center was a feasible, cost-effective way to increase the reach of treatment (primarily NRT) and to increase short-term quit rates. Trial registration This study is registered at Clinicaltrials.gov NCT01321944.