Impact of Adding Telephone-Based Care Coordination to Standard Telephone-Based Smoking Cessation Counseling Post-hospital Discharge: a Randomized Controlled Trial
Cessation counseling and pharmacotherapy are recommended for hospitalized smokers, but better coordination between cessation counselors and providers might improve utilization of pharmacotherapy and enhance smoking cessation.
To compare smoking cessation counseling combined with care coordination post-hospitalization to counseling alone on uptake of pharmacotherapy and smoking cessation.
Unblinded, randomized clinical trial
Hospitalized smokers referred from primarily rural hospitals
Counseling only (C) consisted of telephone counseling provided during the hospitalization and post-discharge. Counseling with care coordination (CCC) provided similar counseling supplemented by feedback to the smoker’s health care team and help for the smoker in obtaining pharmacotherapy. At 6 months post-hospitalization, persistent smokers were re-engaged with either CCC or C.
Utilization of pharmacotherapy and smoking cessation at 3, 6, and 12 months post-discharge.
Among 606 smokers randomized, 429 (70.8%) completed the 12-month assessment and 580 (95.7%) were included in the primary analysis. Use of any cessation pharmacotherapy between 0 and 6 months (55.2%) and between 6 and 12 months (47.1%) post-discharge was similar across treatment arms though use of prescription-only pharmacotherapy between months 6–12 was significantly higher in the CCC group (30.1%) compared with the C group (18.6%) (RR, 1.61 (95% CI, 1.08, 2.41)). Self-reported abstinence rates of 26.2%, 20.3%, and 23.4% at months 3, 6, and 12, respectively, were comparable across the two treatment arms. Of those smoking at month 6, 12.5% reported abstinence at month 12. Validated smoking cessation at 12 months was 19.3% versus 16.9% in the CCC and C groups, respectively (RR, 1.13 (95% CI, 0.80, 1.61)).
Supplemental care coordination, provided by counselors outside of the health care team, failed to improve smoking cessation beyond that achieved by cessation counseling alone. Re-engagement of smokers 6 months post-discharge can lead to new quitters, at which time care coordination might facilitate use of prescription medications.
KEY WORDSsmoking cessation care coordination transition of care
The authors would like to thank the hospitals throughout the state of Kansas that participated in this study and the volunteers who participated in this research.
This work was supported by the National Cancer Institute of the National Institutes of Health grant number R01CA101963. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health. This trial was registered on clinicaltrials.gov (NCT01063972).
Compliance with Ethical Standards
All study procedures were reviewed and approved by the KUMC institutional review board.
Conflict of Interest
Drs. Ellerbeck, Cox, Hui, Keighley, Hutcheson, Cupertiono, Greiner, Miller, Rabius, and Richter and Ms. Fitzgerald report grants from the National Institutes of Health during the conduct of the study.
Dr. Rigotti reports grants from NCI, during the conduct of the study; personal fees from UpToDate, Inc.; personal fees from Achieve Life Sciences; and grants and non-financial support from Pfizer, outside the submitted work.
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