Effectiveness of an on-call counselor at increasing smoking treatment.
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.
Sherman
Scott E
SE
VA Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, CA, USA. scott.sherman@va.gov
Estrada
Maribel
M
Lanto
Andy B
AB
Farmer
Melissa M
MM
Aldana
Ileana
I
D003376:Counseling; D015277:Hotlines; D006801:Humans; D016540:Smoking Cessation