Evidence-based Cessation Counseling Research Articles

Implementation, Maintenance, and Outcomes of an Electronic Referral to a Tobacco Quitline Across Five Health Systems.

Electronic referral (e-referral) to quitlines helps connect tobacco-using patients to free, evidence-based cessation counseling. Little has been published about the real-world implementation of e-referrals across U.S. health systems, their maintenance over time, and the outcomes of e-referred patients. Beginning in 2014, the University of California (UC)-wide project called UC Quits scaled up quitline e-referrals and related modifications to clinical workflows from one to five UC health systems. Implementation strategies were used to increase site readiness. Maintenance was supported through ongoing monitoring and quality improvement programs. Data on e-referred patients (n = 20 709) and quitline callers (n = 197 377) were collected from April 2014 to March 2021. Analyses of referral trends and cessation outcomes were conducted in 2021-2022. Of 20 709 patients referred, the quitline contacted 47.1%, 20.6% completed intake, 15.2% requested counseling, and 10.9% received it. In the 1.5-year implementation phase, 1813 patients were referred. In the 5.5-year maintenance phase, volume was sustained, with 3436 referrals annually on average. Among referred patients completing intake (n = 4264), 46.2% were nonwhite, 58.8% had Medicaid, 58.7% had a chronic disease, and 48.8% had a behavioral health condition. In a sample randomly selected for follow-up, e-referred patients were as likely as general quitline callers to attempt quitting (68.5% vs. 71.4%; p = .23), quit for 30 days (28.3% vs. 26.9%; p = .52), and quit for 6 months (13.6% vs. 13.9%; p = .88). With a whole-systems approach, quitline e-referrals can be established and sustained across inpatient and outpatient settings with diverse patient populations. Cessation outcomes were similar to those of general quitline callers. This study supports the broad implementation of tobacco quitline e-referrals in health care. To the best of our knowledge, no other paper has described the implementation of e-referrals across multiple U.S. health systems or how they were sustained over time. Modifying electronic health records systems and clinical workflows to enable and encourage e-referrals, if implemented and maintained appropriately, can be expected to improve patient care, make it easier for clinicians to support patients in quitting, increase the proportion of patients using evidence-based treatment, provide data to assess progress on quality goals, and help meet reporting requirements for tobacco screening and prevention.

Effect of Nicotine Replacement Therapy on Quitting by Young Adults in a Trial Comparing Cessation Services

Young adult smokers have the highest smoking prevalence among all US age groups but are least likely to use evidence-based cessation counseling or medication to quit. Use and effectiveness of nicotine patch were explored in a randomized trial evaluating smoking cessation interventions with this population. Smokers aged 18 to 30 (n = 3094) were recruited through online and off-line methods and from telephone quit lines and analyzed. Smokers were enrolled in a pretest-posttest trial, and randomized to 1 of 3 cessation services. Trial delivering counseling services by self-help booklet, telephone quit lines, or online expert system in the 48 continental United States. Smokers could request a free 2-week course of nicotine replacement therapy (NRT) patches from the project. Follow-up surveys at 12 and 26 weeks assessed smoking abstinence, use of NRT, counseling, and other cessation medications, and smoking-related variables. Overall, 69.0% of smokers reported using NRT (M = 3.2 weeks) at 12 weeks and 74.8% (M = 3.3 weeks) at 26 weeks. More smokers who were sent the free nicotine patches (n = 1695; 54.8%) reported using NRT than those who did not receive them (12 weeks: 84.3% vs 41.9%, P < .001; 26 weeks: 87.6% vs 51.1%, P < .001). The use of NRT was associated with greater smoking abstinence at 12 weeks (P < .001) and 26 weeks (P < .05), especially if used for more than 2 weeks (P < .001). Smokers assigned to a self-help booklet or cessation Web site and heavier smokers were most likely to use NRT (P < .05), whereas those reporting marijuana use and binge drinking used NRT less (P < .05). Many young adults were willing to try NRT, and it appeared to help them quit in the context of community-based cessation services. Strategies should be developed to make NRT available to this age group and support them in using it to prevent lifelong smoking.

Many Smoking-Cessation Failures Linked to Lack of Professional Help

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessMany Smoking-Cessation Failures Linked to Lack of Professional HelpLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:3 Feb 2012https://doi.org/10.1176/pn.47.3.psychnews_47_3_26-bAbstractMost smokers want to quit smoking, and more than half have tried to quit in the prior year. But those who are trying to quit aren’t receiving the help and support they need.Most American adults who smoke wish they could quit.Roman Sigaev/ShutterstockAccording to a report in the November 11, 2011, Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), 68.8 percent of current cigarette smokers said they would like to stop smoking completely, and 52.4 percent had tried to quit smoking in the preceding year. But 68.3 percent of the smokers who tried to quit did so without using evidence-based cessation counseling or medications, and only 48.3 percent of those who had visited a health care professional in the prior year reported receiving advice on how to quit smoking.The report was published in conjunction with the annual Great American Smokeout, observed last year on November 17. The Smokeout, sponsored by the American Cancer Society, urges smokers to use the date to make a plan to quit or to plan in advance and quit smoking that day.In a press release, CDC Director Thomas Frieden, M.D., M.P.H., said, “Smokers who try to quit can double or triple their chances by getting counseling, medicine, or both.”The CDC’s conclusions were based on an analysis of data from the 2001 to 2010 National Health Interview Surveys (NHIS). The NHIS is a continuous, nationwide in-person survey of approximately 35,000 households, or about 87,500 individuals, in the civilian noninstitutionalized population, conducted by the CDC’s National Center for Health Statistics and administered by the U.S. Census Bureau.First administered in 1957, the NHIS consists of two parts: a core set of basic health and demographic questions on a broad range of topics, and one or more sets of supplemental questions on specific health topics.The CDC’s goal in the current analysis was to determine the prevalence of the current interest in quitting smoking, as well as data on successful recent smoking cessation, recent use of cessation treatments, and trends in quit attempts over a 10-year period.The 2010 NHIS interviewed 27,157 individuals aged 18 and older. Current smokers were characterized as those who had smoked at least 100 cigarettes during their lifetime and, at the time of the interview, reported smoking every day or occasionally. New to the 2010 interview was a supplemental questionnaire that focused on cancer and its risk factors and contained questions on interest in quitting smoking, receipt of a health professional’s advice to quit, and use of cessation counseling and medication.The CDC said the report’s implications for public-health practices include a need for health care providers to consistently and routinely identify tobacco users, advise them to quit, and provide assistance to those engaged in a quit attempt. CDC officials also emphasized that population-based interventions that effectively increase cessation, including expanding tobacco cessation quitlines and health-insurance coverage for cessation treatments, should be implemented.“Quitting Smoking Among Adults— United States, 2001-2010” is posted at www.cdc.gov/mmwr/preview/mmwrhtml/mm6044a2.htm. ISSUES NewArchived