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Journal of General Internal Medicine

, Volume 34, Issue 12, pp 2804–2811 | Cite as

Impact of Adding Telephone-Based Care Coordination to Standard Telephone-Based Smoking Cessation Counseling Post-hospital Discharge: a Randomized Controlled Trial

  • Edward F. EllerbeckEmail author
  • Lisa Sanderson Cox
  • Siu-kuen Azor Hui
  • John Keighley
  • Tresza D. Hutcheson
  • Sharon A. Fitzgerald
  • A. Paula Cupertino
  • K. Allen Greiner
  • Nancy A. Rigotti
  • Nancy Houston Miller
  • Vance Rabius
  • Kimber P. Richter
Original Research

Abstract

Background

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.

Objective

To compare smoking cessation counseling combined with care coordination post-hospitalization to counseling alone on uptake of pharmacotherapy and smoking cessation.

Design

Unblinded, randomized clinical trial

Participants

Hospitalized smokers referred from primarily rural hospitals

Interventions

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.

Main Measures

Utilization of pharmacotherapy and smoking cessation at 3, 6, and 12 months post-discharge.

Key Results

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)).

Conclusion

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.

Trial Registration

NCT01063972

KEY WORDS

smoking cessation care coordination transition of care 

Notes

Acknowledgments

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.

Funding

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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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Edward F. Ellerbeck
    • 1
    Email author
  • Lisa Sanderson Cox
    • 1
  • Siu-kuen Azor Hui
    • 2
  • John Keighley
    • 3
  • Tresza D. Hutcheson
    • 1
  • Sharon A. Fitzgerald
    • 1
  • A. Paula Cupertino
    • 1
  • K. Allen Greiner
    • 4
  • Nancy A. Rigotti
    • 5
  • Nancy Houston Miller
    • 6
  • Vance Rabius
    • 7
  • Kimber P. Richter
    • 1
  1. 1.Department of Population Health University of Kansas Medical CenterKansas CityUSA
  2. 2.Philadelphia Department of Public HealthPhiladelphiaUSA
  3. 3.Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityUSA
  4. 4.Department of Family MedicineUniversity of Kansas Medical CenterKansas CityUSA
  5. 5.Division of General Internal MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  6. 6.The LifeCare CompanyMenlo ParkUSA
  7. 7.Department of Behavioral ScienceUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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