Implementing a tobacco assisted referral program in dental practices.
OBJECTIVE
The objectives of this study are to design and implement a system-level tobacco-control intervention in a large prepaid dental group practice and assess effects on staff performance measures and patient satisfaction.


METHODS
We matched 14 dental facilities on size, socioeconomic status, smoking rate, and periodontal status, and then randomly assigned them to intervention or usual-care control. We trained intervention staff in an "Assisted Referral" team approach for assessing tobacco use, providing tailored advice and brief counseling, and encouraging smokers to talk by telephone with a specially trained tobacco counselor. Patients could call from the office or ask that the counselor call them later. Telephone counselors helped patients explore motivations and barriers for quitting; review available cessation-support strategies, programs, and medications; and identify next steps.


RESULTS
During the 14-month study period, 66,516 members had annual- or new-patient examinations. Both intervention and control sites had high rates of tobacco assessment (97 percent) and advice (93 percent). Intervention patients were more likely than controls (69 percent versus 3 percent, P < 0.01) to receive additional chair-side tobacco counseling and assistance, and 11 percent agreed to receive additional telephone counseling. Intervention patients were more satisfied than controls with the dental team's tobacco-control efforts (P < 0.03). Referral rates varied substantially for different staff.


CONCLUSIONS
The Assisted Referral approach was successfully integrated into routine dental care, was well received by patients, and resulted in increased patient satisfaction. Because free telephone-based tobacco counseling is now available nationwide, the approach may be a practical strategy for most dental-care settings.
Little
Sally J
SJ
Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR 97227-1110, USA.
Hollis
Jack F
JF
Fellows
Jeffrey L
JL
Snyder
John J
JJ
Dickerson
John F
JF
D001521:Behavior Therapy / Q000379:methods; D003376:Counseling; D003749:Dental Facilities; D005260:Female; D006284:Health Plan Implementation; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015397:Program Evaluation; D012017:Referral and Consultation; D013689:Telephone; D020340:Tobacco Use Cessation / Q000379:methods*; D057170:Translational Research, Biomedical / Q000379:methods