Ask-Advise-Connect: A New Approach to Smoking Treatment Delivery in Health Care Settings
Thursday, February 28, 2013
Posted by: Natalia Gromov
Intern Med. Published online February 25, 2013.
Irvin Vidrine, Sanjay Shete, Yumei Cao, Anthony
Greisinger, Penny Harmonson, Barry Sharp, Lyndsay Miles, Susan M. Zbikowski,
David W. Wetter
Importance: Several national
health care–based smoking cessation initiatives have been recommended to
facilitate the delivery of evidence-based treatments, such as quitline
(telephone-based tobacco cessation services) assistance. The most notable
examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise.
Refer. (AAR) programs. Unfortunately, rates of primary care referrals to
quitlines are low, and most referred smokers fail to call for assistance.
Objective: To evaluate a new
approach—Ask-Advise-Connect (AAC)—designed to address barriers to linking
smokers with treatment.
Design: A pair-matched,
2-treatment-arm, group-randomized design in 10 family practice clinics in a
single metropolitan area. Five clinics were randomized to the AAC
(intervention) and 5 to the AAR (control) conditions. In both conditions,
clinic staff were trained to assess and record the smoking status of all
patients at all visits in the electronic health record, and smokers were given
brief advice to quit. In the AAC clinics, the names and telephone numbers of
smokers who agreed to be connected were sent electronically to the quitline
daily, and patients were called proactively by the quitline within 48 hours. In
the AAR clinics, smokers were offered a quitline referral card and encouraged
to call on their own. All data were collected from February 8 through December
Setting: Ten clinics in
Participants: Smoking status
assessments were completed for 42 277 patients; 2052 unique smokers were
identified at AAC clinics, and 1611 smokers were identified at AAR clinics.
Interventions: Linking smokers with
Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and
Maintenance) conceptual framework and defined as the proportion of all
identified smokers who enrolled in treatment.
Results: In the AAC clinics,
7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics
9.19 [P < .001];
odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion
of smokers enrolling in treatment.
The system changes implemented in the AAC approach could be adopted broadly by
other health care systems and have tremendous potential to reduce
tobacco-related morbidity and mortality.
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