• Stephen F Rothemich, Steven H Woolf, Robert E Johnson, Kelly J Devers, Sharon K Flores, Pamela Villars, Vance Rabius, and Tim McAfee.
• Department of Family Medicine, Virginia Commonwealth University, Richmond, 23298-0251, USA. srothemich@vcu.edu
• Am J Prev Med. 2010 Apr 1; 38 (4): 367374367-74.

BackgroundCounseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work. Telephone quitlines can deliver effective intensive counseling, but few collaborate closely with clinicians.PurposeThis study aimed to determine whether cessation support in practices is enhanced by a systems approach, in partnership with quitlines.DesignA cluster RCT was used.Setting/ParticipantsParticipants included 1817 adult smokers from 16 primary care practices in the Virginia Ambulatory Care Outcomes Research Network.InterventionAn expanded tobacco-use "vital sign" intervention (identify smokers, advise cessation, and assess readiness to quit) that was combined with fax referral of preparation-stage smokers to a quitline providing feedback to practices was compared to a traditional tobacco-use vital sign alone.Main Outcome MeasuresThe frequency of cessation support (in-office discussion of methods to quit or quitline referral) reported by patients in an exit survey (September 2005-July 2006, analyzed in 2008) was measured.ResultsThe adjusted percentage of smokers who reported receiving cessation support differed by 12.5% in intervention and control practices (40.7% vs 28.2%, respectively; p<0.001). Both in-office discussion of methods to quit and quitline referral increased significantly with the intervention. Post hoc analysis revealed that the increase in cessation was stable for both patient gender and visit type and was more pronounced with patients aged 35-54 years and with male and more experienced clinicians.ConclusionsA systems approach to identifying smokers, advising and assessing readiness to quit, combined with a partnership with a quitline, increases delivery of cessation support for primary care patients beyond that accomplished by traditional tobacco-use vital sign screening alone.Clinical Trial RegistrationNCT00112268.2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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