Trial Information

Quitlink : A Leveraging Solution to Tobacco Counseling

Among the most important evidence-based interventions in primary care is to offer counseling
and pharmacotherapy to patients who use tobacco, but studies suggest that only a fraction of
tobacco users receive this assistance. Office systems and other strategies can improve
counseling rates but are not widely adoptable in primary care. We propose a novel solution
that couples a simple office system, which is widely adoptable, with a form of third-party
counseling (telephone quit lines) that most practices can access in the United States.
Specifically, the three-part intervention includes (1) an in-office expanded “vital signs”
intervention that prompts nurses (or medical assistants) to determine tobacco use status,
offer brief advice, and assess readiness to quit as vital signs are obtained; (2) inviting
preparation-stage tobacco users to obtain proactive telephone counseling (provided by the
American Cancer Society) comprising three 30-minute sessions scheduled at the patient’s
convenience; and (3) feedback from the Society to the practice, including fax requisitions
for prescription aids for quit attempts, progress reports on the results of counseling, and
quarterly aggregate analyses of practice and clinician team referral outcomes. The Virginia
Ambulatory Care Outcomes Research Network will partner with the American Cancer Society to
test this strategy in a randomized controlled trial conducted at 16 primary care practices
in Virginia. Because existing dissemination strategies serve mainly to increase
identification of tobacco users and sometimes to increase brief advice, our primary outcome
measure will be the proportion of tobacco users who receive substantive assistance: Assess,
Assist, and Arrange of the 5As. Given the widening availability of state and national quit
line programs, our model for referrals and bidirectional communication with primary care
could markedly augment the effectiveness of both primary care and quit lines in promoting
tobacco cessation and provide an attractive alternative for clinicians who lack the time and
resources to provide effective counseling.