Telephone care co-ordination for tobacco cessation : randomised trials testing proactive versus reactive models
Mené auprès de 3 120 fumeurs, cet essai compare, du point de vue du taux d'abstinence tabagique à 6 mois, l'efficacité de deux approches d'aide au sevrage tabagique, l'une reposant sur plusieurs entretiens téléphoniques destinés à accompagner les fumeurs dans leur tentative d'arrêter le tabagisme, l'autre consistant à délivrer du matériel pédagogique et des conseils téléphoniques sur les traitements anti-tabagiques
Objectives : We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. Methods : Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers’ Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. Outcome : Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). Conclusion : Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible. Trial registration number : NCT00123682.