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Randomized Controlled Trial
. 2013 Dec;45(6):737-41.
doi: 10.1016/j.amepre.2013.07.011.

The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial

Jennifer Irvin Vidrine  1 , Sanjay Shete, Yisheng Li, Yumei Cao, Margo Hilliard Alford, Michelle Galindo-Talton, Vance Rabius, Barry Sharp, Penny Harmonson, Susan M Zbikowski, Lyndsay Miles, David W Wetter
Affiliations
Randomized Controlled Trial

The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial

Jennifer Irvin Vidrine et al. Am J Prev Med. 2013 Dec.

Abstract

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.

Purpose: 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.

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

Setting/participants: Ten safety net clinics in Houston TX.

Intervention: 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.

Main outcome measures: 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.

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Conflict of interest statement

Conflict of Interest Statement: Dr. Jennifer Irvin Vidrine was awarded a grant from the CDC to support the study described in this manuscript (R18DP001570. Her work has also been supported by the NIH and the Cancer Prevention Research Institute of Texas (CPRIT). Dr. Sanjay Shete’s work has also been supported by the NIH and CPRIT. Dr. Yisheng Li’s work has been supported by the CDC and the NIH. Dr. Vance Rabius has served as a consultant on a CDC contract awarded to RTI International and has received funding from the CDC, NIH, and the American Cancer Society. Ms. Penny Harmonson and Mr. Barry Sharp are with the Texas Department of State Health Services, Tobacco Prevention & Control Program, which receives funding from the Texas legislature appropriation of state tobacco settlement and general revenue funds, the CDC, and the FDA. Ms. Cao, Dr. Alford, and Ms. Galindo-Talton have no financial disclosures. Dr. Susan Zbikowski’s work has been supported by the NIH, state agencies, and the CDC. Dr. Zbikowski is an employee of Alere Wellbeing, the service provider for the Texas Quitline. Ms. Lyndsay Miles’s work has been supported by the NIH, the Centers for Medicare and Medicaid Services, and CPRIT. Ms. Miles is an employee of Alere Wellbeing, the service provider for the Texas Quitline. Dr. David Wetter has received grants from the NIH and CPRIT.

Figures

Figure 1
Figure 1
CONSORT Flow Diagram
Figure 2
Figure 2
Reach, Efficacy, and Impact for AAC and AAR Notes: Reach = proportion of smokers identified who talked with Quitline; Efficacy = proportion of smokers who talked with Quitlline that enrolled in treatment; Impact = Reach × Efficacy
See this image and copyright information in PMC

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