This project aims to make smoking cessation an area of excellence for two VA networks by adapting and expanding the primary care-based Telephone Care Coordination Program (TCCP) throughout Sierra Pacific Healthcare Network (VISN 21) and Desert Pacific Healthcare Network (VISN 22). Current VA policy and new VA/DoD guidelines both mandate that patients be offered treatment (medications and counseling), regardless of whether they attend a smoking cessation program. This makes it essential to treat patients within primary care, since most smokers interested in quitting cannot or will not attend a cessation program. Current data on treatment rates in VISNs 21 and 22 show that in spite of the fact that over 60% of smokers report trying to quit in the prior year, only about 7% were actually given treatment to assist them in quitting.

This regional expansion builds on a very successful VA Substance Use Disorder QUERI demonstration project at two facilities. Across the 10 intervention sites, there were 2,900 referrals for smoking cessation in 10 months. VA care coordinators proactively contacted patients and connected them with the California Smokers'''' Helpline. Thus far, 45% of patients starting treatment were abstinent six months later -- equal to or better than smoking cessation clinics. A cost analysis shows substantial savings per quitter compared to provider and clinic-based programs.

Background: This project aims to make smoking cessation an area of excellence for two VA networks by adapting and expanding the primary care-based Telephone Care Coordination Program (TCCP) throughout Sierra Pacific Healthcare Network (VISN 21) and Desert Pacific Healthcare Network (VISN 22). Current VA policy and new VA/DoD guidelines both mandate that patients be offered treatment (medications and counseling), regardless of whether they attend a smoking cessation program. This makes it essential to treat patients within primary care, since most smokers interested in quitting cannot or will not attend a cessation program. Current data on treatment rates in VISNs 21 and 22 show that in spite of the fact that over 60% of smokers report trying to quit in the prior year, only about 7% were actually given treatment to assist them in quitting.

This regional expansion builds on a very successful VA Substance Use Disorder QUERI demonstration project at two facilities. Across the 10 intervention sites, there were 2,900 referrals for smoking cessation in 10 months. VA care coordinators proactively contacted patients and connected them with the California Smokers'''' Helpline. Thus far, 45% of patients starting treatment were abstinent six months later -- equal to or better than smoking cessation clinics. A cost analysis shows substantial savings per quitter compared to provider and clinic-based programs.

Objectives: The objectives of the study are to:

1. Determine the effect of the Telephone Care Coordination Program on increasing smoking cessation treatment rates. 2. Determine how a proactive approach to telephone counseling compares with a reactive approach. 3. Determine how intensive telephone counseling compares with brief PC-based counseling plus self-help materials. 4. Gather information needed for possible national implementation of this approach to smoking cessation, including feasibility, acceptability, impact and cost

Methods: This project is a group randomized trial testing whether TCCP increases the rate of smoking cessation treatment. At the patient level, two questions are addressed: 1) Is proactive care coordination (counselor initiates the call to the patient) more effective than reactive coordination (coordinator waits for the patient to call)? 2) Is multi-session counseling more effective than brief primary care-based counseling plus self-help materials? Using a two-by-two factorial design, we will randomly allocate all sites within VISNs 21 and 22 to one of these four groups. All patients will receive brief smoking cessation counseling from their primary care physician, smoking cessation medications (once they are in contact with the VA care coordinator), and a follow-up call at 6 months. Care coordination will be provided by VA clinical staff (donated as in-kind support from the participating facilities). Intensive counseling will be provided by the California Smokers'''' Helpline.

Findings: For this planning grant, we spent 6 months working with VISN 21, VISN 22, and the California Smokers’ Helpline to develop a grant proposal/project that would help the VA plan for national implementation of a program to help improve smoking cessation care throughout the VA. The grant was successfully submitted and as of 9/04 was Conditionally Approved.

Status: The planning grant is completed.

Impact: It is likely that the VA will be creating a national smoking cessation Quitline in the next few years. The study submitted as a result of the planning grant will give crucial information to help inform the national discussion regarding Quitlines and other tobacco control issues.

Inclusion Criteria: VA patient Smoker Patient wants to quit smoking

Exclusion Criteria: