University of Iowa News Release
April 21, 2004
Comprehensive Intervention Helps Smokers Quit
While people sometimes are asked during primary care clinic visits whether they smoke, those who do smoke are not often offered the tools to quit. However, a study shows that a proactive, cost-efficient approach that includes brief counseling by nurses and medical assistants, follow-up telephone counseling and free drug therapy may help smokers quit.
The investigation revealed a nearly six percent increase in self-reported quit rates among people in the intervention group compared to a group receiving usual care. If put into practice for the 70 percent of smokers in the United States who visit their physicians at least once a year, the program could result in two million fewer smokers annually.
The study was led by David Katz, M.D., formerly of the University of Wisconsin-Madison and now on faculty at the University of Iowa. The findings appear in the April 21 issue of the Journal of the National Cancer Institute.
"This study evaluated a guideline-based intervention that was designed to be feasible in a busy primary care practice setting. We wanted to see what could be achieved by making it easier for patients who wanted to quit smoking to get both pro-active counseling and free over-the-counter pharmacotherapy rather than having them call a quit line or ask their physician for a prescription," said Katz, associate professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine, and epidemiology in the UI College of Public Health.
The investigation was based on a 1996 recommendation, updated in 2000, by the Agency for Healthcare Research and Quality (AHRQ) that all clinicians strongly advise their patients who use tobacco to quit. The AHRQ also provides suggestions on how to intervene. The study targeted training intake clinicians -- nurses and medical assistants -- to do the intervention, in part because physicians often lack time during office visits.
"I think the AHRQ guideline really called attention to the need for a systems-based approach to smoking cessation," Katz said. "Our study was unique by combining key components that, in isolation, have been shown in previous studies to be effective in clinical trials."
The study included eight primary care clinics (four test sites and four control sites) in southern Wisconsin and enrolled 2,163 adults who smoked at least one cigarette per day. Intake clinicians were instructed to ask patients if they smoked and determine their willingness to quit. For those patients interested in quitting, the clinicians helped set a quit date and provided information on quitting, as well as vouchers for free nicotine patches. This initial protocol took only two to three minutes.
Participating patients were followed with proactive telephone counseling by an experienced cessation counselor to assist in their efforts to quit. Based on self-reporting at the six-month interval after their initial office visit, 15.4 percent of the intervention patients reported they had quit smoking, whereas only 9.8 percent of the individuals from the control sites reported quitting.
Although a limitation of the study was its use of self-report to determine abstinence from smoking, the results still indicate a positive effect of the intervention even after accounting for possible misreporting of abstinence, said Katz, who also is a researcher with the Iowa City Veterans Affairs Medical Center.
The estimated cost per self-reported quitter was about $1,822, which Katz said reflects a very cost-efficient use of resources compared to commonly accepted health care interventions.
He added that the nurses and physician medical assistants in the study really "stepped up to the plate" and demonstrated their capacity for engaging patients in brief cessation counseling.
"Although intake clinicians were very concerned about the two to three minutes required for brief counseling at the outset of the study, I think nearly all of the clinic staff in this study recognized that this was a minuscule investment in trying to improve the health of their patients," Katz said
Possible next steps for this line of research, Katz said, will be to investigate other methods to integrate brief smoking cessation counseling and effective pharmacotherapy into primary care practice, particularly for patients with chronic conditions.
Support for the study included a grant from the National Cancer Institute (NCI) and in-kind support from the University of Wisconsin Comprehensive Cancer Center.
The published findings were accompanied by a supportive editorial. The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute, which is part of the National Institutes of Health. Visit the journal online at http://www.jncicancerspectrum.oupjournals.org/.
For information on smoking cessation, visit http://www.uihealthcare.com/depts/cancercenter/patienteducation/lungsmoking.html .
Information on tobacco issues also is available at the Iowa Tobacco Research Center (ITRC) Web site http://www.public-health.uiowa.edu/itrc/. The ITRC is operated by the Department of Community and Behavioral Health in the UI College of Public Health.
University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at http://www.uihealthcare.com.
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