Primary care intervention significantly improves smoking cessation

Primary care clinics that implemented an outreach intervention had a greater proportion of patients who converted from current to former smokers than clinics without the intervention, according to findings published in Preventive Medicine.

“A comprehensive, health system-wide approach to smoking treatment in adult primary care may markedly improve smoking cessation treatment delivery and success,” Danielle E. McCarthy, MS, PhD, the associate director of research at the University of Wisconsin Center for Tobacco Research and Intervention, and colleagues wrote. “This program increased the reach of cessation treatment and rates of conversion to former smoking and was especially effective in engaging traditionally underserved groups in smoking treatment.”

In a pragmatic, population-based study, McCarthy and colleagues evaluated the success of the Comprehensive Tobacco Intervention Program (CTIP) at six adult primary care clinics in Madison, Wisconsin. The analysis included data on 6,894 patients.

The program used electronic health record tools that allowed clinicians to deliver pharmacotherapy and counseling, guide tobacco cessation outreach specialists (TCOS) with phone outreach efforts, and prompt multimethod bulk outreach to all patients on a smoking registry in the past 1 to 3 years. Each treatment outreach method was conducted with an opt-out approach and occurred no more than once every 90 days.

CTIP was launched in three waves. The researchers categorized the different phases as:

• Period 1, the baseline period before any clinics implemented the program (January 2017 to December 2017);

• Period 2, in which two clinics were actively implementing the program while the other four were inactive (January 2018 to June 2018);

• Period 3, in which four clinics were actively implementing the program (July 2018 to October 2018); and

• Period 4, in which all six clinics were actively implementing the program (November 2018 to February 2020).

Overall, cessation treatment reach increased significantly after CTIP launched in five of six clinics and was significantly higher when clinics had an active CTIP, according to the researchers. Raw rates of change in smoking cessation increased from 0.4% in inactive clinics to 6.9% in active clinics in Period 2, from 0.7% in inactive clinics to 6.6% in active clinics in Period 3, and from 2.1% at Period 1 to 10.5% in Period 4.

When CTIP was active in all six clinics, 24% of adult patients who smoked received some form of smoking treatment, McCarthy and colleagues reported. About one in six of those reached made a quit plan and accepted smoking-cessation medication. Also, 30.1% of patients with target quit days in the previous 6 weeks reported success in quitting or willingness to set a new quit date.

The researchers found that the program was especially effective in reaching historically underrepresented populations. TCOS reach rates were particularly high for women, African American patients, Hispanic patients and those with Medicaid. Among all patients who received TCOS outreach, fewer than 7% initiated contact with a TCOS. However, “this approach was relatively inexpensive and more than one-third of those who initiated contact with a TCOS accepted pharmacotherapy,” McCarthy and colleagues wrote.

Rates of smoking cessation were substantially higher in clinics implementing CTIP than in those at baseline, with increases in quit rates corresponding to active CTIP implementation. In addition, quit rates more than doubled from 2.1% in the year before CTIP launched to 4.4% during the 15 months all six clinics were implementing CTIP.

“A distinguishing feature of CTIP was proactive outreach by phone to both patients who recently saw a primary care provider and those who had not visited a clinic for at least a year,” McCarthy and colleagues wrote. “Both primary care clinicians and tobacco cessation specialists delivered smoking cessation advice and support in CTIP.”