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Multicenter Study
. 2019 Aug;34(8):1571-1577.
doi: 10.1007/s11606-019-05079-3. Epub 2019 Jun 13.

Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network

Sara Kalkhoran  1   2   3 , Elizabeth M Inman  4   5 , Jennifer H K Kelley  4   5 , Jeffrey M Ashburner  6   7 , Nancy A Rigotti  4   6   7   5
Affiliations
Multicenter Study

Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network

Sara Kalkhoran et al. J Gen Intern Med. 2019 Aug.

Abstract

Background: Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters.

Objective: To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters.

Design: 3-arm pragmatic randomized controlled trial.

Participants: Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls.

Interventions: One intervention group involved engagement with a health system-based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral).

Measurements: Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment.

Key results: Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p < 0.001), cessation medication prescription (52% vs. 30%, p = 0.002), and counseling (47% vs. 9%, p < 0.001). Internal care coordination was more effective than external community referral at connecting smokers to any cessation treatment (76% vs. 50%, p = 0.001) and at providing cessation medication (66% vs. 39%, p < 0.001), but comparable at linking smokers to cessation counseling resources.

Conclusions: Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates.

Trial registration: ClinicalTrials.gov NCT03612895.

Keywords: clinical trials; population health; primary care; smoking cessation.

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Conflict of interest statement

Drs. Rigotti and Kalkhoran receive royalties from UpToDate, Inc. Dr. Rigotti has been an unpaid consultant to Pfizer, Inc. and a paid consultant to Achieve Life Sciences. No other authors have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Consort diagram.
See this image and copyright information in PMC

References

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