Telephone-Based Coaching

Abstract

Purpose: Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations.

Design: Retrospective cohort study comparing wellness coaching participants with two groups of controls.

Setting: Kaiser Permanente Northern California, a large integrated health care delivery system.

Subjects: Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan.

Measures: Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up.

Analysis: Logistic regressions adjusting for age, gender, race/ethnicity, and primary language.

Results: After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p < .001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p < .001).

Conclusion: Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

Keywords: Health focus: smoking control; Manuscript format: research; Motivational Interviewing; Outcome measure: behavioral; Prevention Research; Program Evaluation; Research purpose: program evaluation; Setting: clinical/health care; Strategy: behavior change; Study design: quasi-experimental; Target population age: adults; Target population circumstances: geographic location; Tobacco Cessation; Wellness Coaching.

Figure 1. Percent of Former Tobacco Users Among Wellness Coaching Participants, Matched Controls, and Class Attendees*†

* After adjusting for age, gender, race/ethnicity, primary language, tobacco use at baseline, and tobacco medication fill at baseline, the quit rate among wellness coaching participants at follow-up (31%) was statistically different from that of the matched controls (23%, P<0.001) but not that of the class attendees (29%, P=0.28). † After adjusting for age, gender, race/ethnicity, primary language, and tobacco medication fill at baseline, there was a significant increase in the quit rate between baseline and follow-up within each group: wellness coaching participants (23%, P<0.001), class attendees (20%, P<0.001), and matched controls (13%, P<0.001).

Figure 2. Percent Who Filled a Tobacco Cessation Medication Among Wellness Coaching Participants, Matched Controls, and Class Attendees*†

* After adjusting for age, gender, race/ethnicity, primary language, tobacco use at baseline, and tobacco medication fill at baseline, the medication fill-rate among wellness coaching participants at follow-up (47%) was statistically different from that of the matched controls (6%, P<0.001) but was not statistically different from that of the class attendees (47%, P=0.93). † After adjusting for age, gender, race/ethnicity, primary language, and tobacco use at baseline, there was a significant difference in the medication fill rate between baseline and follow-up for the wellness coaching participants (37%, P<0.001), class attendees (34%, P<0.001), and matched controls (−2%, P<0.001).