Chronic disease management approach to treating tobacco addiction: comment on "Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit".

Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center, USA.
Archives of internal medicine (Impact Factor: 17.33). 11/2011; 171(21):1907-9. DOI: 10.1001/archinternmed.2011.545
Source: PubMed
2 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Tobacco treatment is underused in primary care. We designed a Tobacco Care Management system to increase the delivery of treatment and reduce the burden on primary care providers (PCPs). A one-click functionality added to the electronic health record (EHR) allowed PCPs to refer smokers to a centralized tobacco treatment coordinator (TTC) who called smokers, provided brief counseling, connected them to ongoing treatment and gave feedback to PCPs. OBJECTIVE: To study the system's feasibility and acceptability among PCPs, and its utilization by smokers. DESIGN: Using a mixed methods design, we documented system utilization quantitatively from February 1, 2010 to July 31, 2011, and conducted two focus groups with PCPs in June 2011. PARTICIPANTS: Thirty-six PCPs and 2,894 smokers from two community health centers in Massachusetts. MAIN MEASURES: Quantitative: One-click referral utilization by PCPs, proportion of smokers referred and connected to treatment. Qualitative: PCPs' reasons for use, barriers to use, and experiences with feedback. KEY RESULTS: Twenty-nine PCPs (81 %) used the functionality more than once, generating 466 referrals for 15 % of known smokers seen during the study. The TTC reached 260 (56 %) of the referrals and connected 135 (29 %) to additional treatment. The director of one center sent PCPs monthly feedback about their utilization compared to peers. These PCPs referred a greater proportion of their known smokers (18 % vs. 9 %, pā€‰<ā€‰0.0001) and reported that monthly feedback motivated referrals. PCPs attending focus groups (nā€‰=ā€‰24) appreciated the system's simplicity, access to updated resources, and time-efficient way to address smoking, and wanted more feedback about cessation outcomes. They collectively supported the system's continuation. CONCLUSIONS: A novel EHR-based Tobacco Care Management system was adopted by PCPs, especially those receiving performance feedback, and connected one-third of referred smokers to treatment. The model has the potential to improve the delivery and outcomes of evidence-based tobacco treatment in primary care.
    Journal of General Internal Medicine 08/2012; 27(12). DOI:10.1007/s11606-012-2174-6 · 3.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care systems using electronic health records (EHRs). The EHR prompted primary care clinic staff to invite patients who smoked to participate in a tobacco treatment program. Patients who accepted and were eligible were offered smoking reduction or cessation treatment. More than 65 % of smokers were invited to participate, and 12.4 % of all smokers enrolled in treatment-30 % in smoking reduction and 70 % in cessation treatment. The chronic care model developed for treating tobacco dependence, integrated into the primary care system through the EHR, has the potential to engage up to 4.3 million smokers in treatment a year.
    Translational Behavioral Medicine 09/2013; 3(3):253-63. DOI:10.1007/s13142-012-0178-8
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: As many smokers experience repeated failures with cessation attempts, it has been postulated that we may create a cadre of highly resistant smokers who are unlikely to engage in treatment or succeed in quitting. Our purpose was to follow a group of recalcitrant rural smokers and examine their ongoing engagement in smoking cessation activities. Methods: At the end of a 24-month disease management program for rural smokers, we identified participants who reported ongoing daily smoking despite exposure to 4 previous cycles of smoking cessation interventions. At month 36 (1 year after conclusion of the study), we contacted these participants and assessed changes in smoking status and ongoing engagement in cessation activities over the preceding 6 months. We assessed quit attempts and use of pharmacotherapy during the prior 6 months, as well as smoking abstinence at 36 months. Findings: Among 333 recalcitrant smokers, 49% reported at least one 24-hour quit attempt during the preceding 6 months, 29% tried smoking cessation pharmacotherapy, and 5% quit smoking. Significant predictors of having at least one 24-hour quit attempt were lower numbers of cigarettes smoked per day, being in preparation stage of change, and more pharmacotherapy-assisted quit attempts during the original 24-month trial. Higher motivation to quit and more previous pharmacotherapy-assisted quit attempts significantly predicted cessation medication use. Use of varenicline was strongly associated with cessation. Conclusions: Many recalcitrant rural smokers continue to engage in treatment and make quit attempts even in the absence of active interventions.
    The Journal of Rural Health 12/2013; 29(1):106-12. DOI:10.1111/j.1748-0361.2012.00415.x · 1.45 Impact Factor