Likewise, in a randomized controlled trial (RCT) involving community-based primary care clinics, Katz7 demonstrated that intake clinicians could also play an important role in smoking cessation (SOR: A). In the study, researchers trained intake clinicians (including registered nurses, license practical nurses, and medical assistants) to identify smokers, provide brief counseling, and assist in their preparation to quit. Patients were offered vouchers for patches and a counselor’s business card. Intake clinicians received periodic feedback on their performance based on exit interviews of the patients. The researchers found that these interventions had a statistically significant effect in moderate-to-heavy smokers in quit attempts, quit rates, and continuous abstinence.
Our patient has a change of heart
At the 3-month follow up, Tammy learned that Ann was still smoking—but she now wanted to quit. Ann said that she’d found a pack of cigarettes in her 14-year-old daughter’s backpack, and felt that the only way to prevent her from getting hooked was to set a good example.
Tammy gave her the state’s quitline number and suggested some online quitting programs. Tammy worked with Ann to choose her target quit date and to pick the Web-based program she was going to use. Ann said that she liked the idea that she could go online whenever she needed support. She also liked the fact that she could put her quit date into the system, so it would give her timely reminders of all her reasons to quit when she logged on.
I wrote Ann a prescription for varenicline and her OCPs, and told her I wanted to see her in 4 weeks. For her part, Tammy added Ann to her list of patients to call the day after her quit date. Tammy makes this her practice with patients because she knows that one well-timed phone call can be the key to a successful quitting attempt.
Outside support improves abstinence rates
Improving your patients’ chances of long-term abstinence hinges, in part, on making the most of outside support. In many cases, your patients can take advantage of them without leaving their homes.
Outside support improves abstinence rates
Quitlines increase quit rates, decrease relapse Telephone counseling is an effective support system.8 Smokers who call to a single number (800-QUITNOW)—a service provided by the National Cancer Institute—are directed to the quitline for their state. Also, smokers can call the National Cancer Institute directly at their quitline (877-44U-QUIT). Calling a quitline provides smokers with real-time counseling and information about how to quit smoking. Quitlines can be appealing to those patients who are uncomfortable discussing their smoking in a group—and it’s free to the patient.
The research supports the use of such help lines. Zhu’s study9 of the California Smokers’ Helpline (SOR: A) was a proactive protocol where smokers were funneled into a research trial when the help line was overwhelmed. The smokers in the treatment arm of this RCT were assigned a counselor who called the smokers as many as 6 times, following a relapse-sensitive schedule. The 12-month abstinence rate increased from 4.1% to 7.5% (P<.001) in the group that had close telephone contact. This improved quit rate reflected both an increase of percentage of smokers who quit and, more importantly, a decrease in quitters who relapsed.
Another prospective RCT10 (SOR: A) enrolled patients from Veterans Affairs (VA) medical centers and involved the same proactive telephone protocol as Zhu used. The treatment group was offered telephone counseling as well as pharmacotherapy; the control group had access to the regular smoking cessation program of the VA system. Regardless of which group an individual was assigned, if that participant used both the counseling and the pharmacotherapy, the quit rate was similar: control (12.7%) and treatment (11.9%). However, only 18% of the controls used both services. The treatment group accessed the combined programs of counseling and medications at a rate of 88%. This led to the difference in 6-month abstinence rates of 13.0% in the treatment group and 4.1% in the control group (OR=3.50; 95% CI, 1.99–6.15). Patients who were directed to and enrolled in treatment programs were therefore more likely to attempt to quit and remain abstinent for up to 6 months.
Web-based programs offer reminders
Like quitlines, Web-based programs offer smokers immediate feedback to help them quit. Many of the programs include links to quitting resources, stories from former smokers and cancer patients, live advice from counselors, and message boards (TABLE 1). Web-based programs have been shown to help improve quit rates.