title: Enhancing smoking cessation of low-income smokers in managed care.
abstract: BACKGROUND
  Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems, it is not clear whether such services are effective for very low-income smokers. We evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care.
  
  
  METHODS
  A randomized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers. All clinicians and center staff received standard training in usual care. Selected nurses and telephone counselors received special training in a computer-assisted counseling program focusing on relapse prevention.
  
  
  RESULTS
  The majority of the study population (233 adult smokers with telephones) were white (64%) women (70%) with annual incomes of less than $10,000 (79%) and with prescriptions of nicotine replacement therapy (>90%). At 3 months, quit rates (smoke-free status verified by carbon monoxide monitors) were 8.1% in the usual-care group and 21% in the telephonic-counseling group (P=.009) by intention-to-treat analysis. Special tracking methods were successful in maintaining participants in treatment.
  
  
  CONCLUSIONS
  Smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephonic-counseling is provided. State and Medicaid managed care plans should consider investing in both office-based nurse and centralized telephonic-counseling services for low-income smokers.
authors.affiliation: Department of Family Practice, Michigan State University, East Lansing 48824, USA. wadland@msu.edu
authors.forename: W C
authors.initials: WC
authors.lastname: Wadland
authors.forename: B
authors.initials: B
authors.lastname: Soffelmayr
authors.forename: K
authors.initials: K
authors.lastname: Ives
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods / Q000592:standards; D003151:Community Health Centers; D003194:Computer-Assisted Instruction / Q000379:methods*; D003376:Counseling / Q000379:methods*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008824:Michigan; D015403:Nursing Evaluation Research; D009818:Office Nursing / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011203:Poverty / Q000523:psychology; D015397:Program Evaluation; D012008:Recurrence; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013689:Telephone