Care coordination to increase referrals to smoking cessation telephone counseling: a demonstration project.
OBJECTIVE
To test the effectiveness of a care coordination program for telephone counseling in raising referral and treatment rates for smoking cessation.


METHODS
A demonstration project implementing a smoking cessation care coordination program offering telephone counseling and medication management to patients referred from primary care.


METHODS
The study was performed at 18 Veterans Health Administration (VA) sites in California. Participants were VA patients receiving primary care. We randomly allocated 10 of 18 sites to receive the Telephone Care Coordination Program, which included simple 2-click referral, proactive care coordination, medication management, and 5 follow-up telephone calls. Each patient received a 30- to 45-minute counseling session from the California Smokers' Helpline. Patients at control sites received usual care.


RESULTS
During 10 months, we received 2965 referrals. We were unable to reach 1156 patients (39%), despite at least 3 attempts. We excluded 73 patients (3%), and 391 patients (13%) were not interested. We connected the remaining 1345 patients (45%) to the Helpline. At 6-month followup, 335 patients (11% of all referrals and 25% of participating patients) were abstinent. Providers at intervention sites reported referring many more patients to telephone counseling than providers at control sites (15.6 vs 0.7 in the prior month).


CONCLUSIONS
The program generated a large number of referrals; almost half of the patients referred were connected with the Helpline. Long-term abstinence was excellent. These results suggest that managed care organizations may be able to improve tobacco control by implementing a similar system of care coordination.
Sherman
Scott E
SE
Veterans Affairs New York Harbor Healthcare System, 423 E 23rd St (Rm 111), New York, NY 10010, USA. scott.sherman@va.gov
Takahashi
Nancy
N
Kalra
Preety
P
Gifford
Elizabeth
E
Finney
John W
JW
Canfield
James
J
Kelly
John F
JF
Joseph
George J
GJ
Kuschner
Ware
W
D002140:California / Q000453:epidemiology; D003376:Counseling; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D012923:Social Class; D013689:Telephone