The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial.
BACKGROUND
Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment.


OBJECTIVE
Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system.


METHODS
The study design was a pair-matched group-randomized trial with two treatment arms.


METHODS
Ten safety net clinics in Houston TX.


METHODS
Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012.


METHODS
The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment.


RESULTS
The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06).


CONCLUSIONS
The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.
Department of Health Disparities Research (Vidrine, Cao, Wetter). Electronic address: jirvinvidrine@mdanderson.org.
Jennifer Irvin
JI
Vidrine
Sanjay
S
Shete
Yisheng
Y
Li
Yumei
Y
Cao
Margo Hilliard
MH
Alford
Michelle
M
Galindo-Talton
Vance
V
Rabius
Barry
B
Sharp
Penny
P
Harmonson
Susan M
SM
Zbikowski
Lyndsay
L
Miles
David W
DW
Wetter
D057286:Electronic Health Records; D054624:Health Status Disparities; D015277:Hotlines; D006801:Humans; D012017:Referral and Consultation; D064876:Safety-net Providers / Q000379:methods; D012907:Smoking / Q000009:adverse effects / Q000191:economics; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013781:Texas; D014029:Tobacco Use Disorder / Q000150:complications / Q000191:economics / Q000534:rehabilitation; D016896:Treatment Outcome