Effectiveness of an On-Call Counselor at Increasing Smoking Treatment

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Abstract
Smoking cessation programs are very effective, but little is known about how to get smokers to attend these programs. To evaluate whether an “on-call” counselor increased smoking cessation program referrals and attendance. We randomly assigned 1 of 2 primary care teams at the Sepulveda VA Ambulatory Care Center to intervention and the other to usual care. The intervention team had access to an on-call counselor who provided counseling and care coordination. Social marketing efforts included educational outreach, provider feedback, and financial incentives. Baseline telephone interviews with a sample of 482 smokers were conducted, covering smoking history, health status, and smoking cessation treatments. Follow-up surveys were conducted at mid-intervention (n = 251) and post-intervention (n = 251). Two hundred ninety-six patients were referred to the on-call counselor, who counseled each patient in person and provided follow-up calls. The counselor referred 45% to the on-site program, and 27% to telephone counseling; of these, half followed through on the referral; 28% declined referral. Patients on the intervention team were more likely to report being counseled about smoking (68% vs 56%; odds ratio [OR] 1.7, CI 1.0–2.9) and referred to a cessation program (38% vs 23%; OR 2.1, CI 1.2–3.6); having attended the program (11% vs 4%; OR 3.6, CI 1.2–10.5); and receiving a prescription for bupropion (17% vs 8%) (OR 2.3, CI 1.1–5.1). The effect was not sustained after the case management period. Having access to an on-call counselor with case management increased rates of smoking cessation counseling, referral, and treatment. The intervention could be reproduced by other health care systems.

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