title: Effectiveness of an on-call counselor at increasing smoking treatment.
abstract: BACKGROUND
  Smoking cessation programs are very effective, but little is known about how to get smokers to attend these programs.
  
  
  OBJECTIVE
  To evaluate whether an "on-call" counselor increased smoking cessation program referrals and attendance.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: VA Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA. scott.sherman@va.gov
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
authors.forename: Maribel
authors.initials: M
authors.lastname: Estrada
authors.forename: Andy B
authors.initials: AB
authors.lastname: Lanto
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.forename: Ileana
authors.initials: I
authors.lastname: Aldana
mesh_terms: D003376:Counseling; D015277:Hotlines; D006801:Humans; D016540:Smoking Cessation