title: Chronic disease management for tobacco dependence: a randomized, controlled trial.
abstract: BACKGROUND
  Tobacco dependence disorder is a chronic relapsing condition, yet treatment is delivered in discrete episodes of care that yield disappointing long-term quit rates.
  
  
  METHODS
  We conducted a randomized controlled trial from June 1, 2004, through May 31, 2009, to compare telephone-based chronic disease management (1 year; longitudinal care [LC]) with evidence-based treatment (8 weeks; usual care [UC]) for tobacco dependence. A total of 443 smokers each received 5 telephone counseling calls and nicotine replacement therapy by mail for 4 weeks. They were then randomized to UC (2 additional calls) or LC (continued counseling and nicotine replacement therapy for an additional 48 weeks). Longitudinal care targeted repeat quit attempts and interim smoking reduction for relapsers. The primary outcome was 6 months of prolonged abstinence measured at 18 months of follow-up.
  
  
  RESULTS
  At 18 months, 30.2% of LC participants reported 6 months of abstinence from smoking, compared with 23.5% in UC (unadjusted, P = .13). Multivariate analysis showed that LC (adjusted odds ratio, 1.74; 95% CI, 1.08-2.80), quit attempts in past year (1.75; 1.06-2.89), baseline cigarettes per day (0.95; 0.92-0.99), and smoking in the 14- to 21-day interval post-quit (0.23; 0.14-0.38) predicted prolonged abstinence at 18 months. The LC participants who did not quit reduced smoking more than UC participants (significant only at 12 months). The LC participants received more counseling calls than UC participants (mean, 16.5 vs 5.8 calls; P < .001), longer total duration of counseling (283 vs 117 minutes; P < .001), and more nicotine replacement therapy (4.7 vs 2.4 boxes of patches; P < .001).
  
  
  CONCLUSIONS
  A chronic disease management approach increases both short- and long-term abstinence from smoking.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00309296.
authors: Department of Medicine, University of Minnesota, Minneapolis, 55414, USA. amjoseph@umn.edu
authors: Anne M
authors: AM
authors: Joseph
authors: Steven S
authors: SS
authors: Fu
authors: Bruce
authors: B
authors: Lindgren
authors: Alexander J
authors: AJ
authors: Rothman
authors: Molly
authors: M
authors: Kodl
authors: Harry
authors: H
authors: Lando
authors: Brandon
authors: B
authors: Doyle
authors: Dorothy
authors: D
authors: Hatsukami
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy; D003376:Counseling; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods*; D017216:Telemedicine; D014029:Tobacco Use Disorder / Q000628:therapy*