Impact of Adding Telephone-Based Care Coordination to Standard Telephone-Based Smoking Cessation Counseling Post-hospital Discharge: a Randomized Controlled Trial

Abstract

Background: Cessation counseling and pharmacotherapy are recommended for hospitalized smokers, but better coordination between cessation counselors and providers might improve utilization of pharmacotherapy and enhance smoking cessation.

Objective: To compare smoking cessation counseling combined with care coordination post-hospitalization to counseling alone on uptake of pharmacotherapy and smoking cessation.

Design: Unblinded, randomized clinical trial PARTICIPANTS: Hospitalized smokers referred from primarily rural hospitals INTERVENTIONS: Counseling only (C) consisted of telephone counseling provided during the hospitalization and post-discharge. Counseling with care coordination (CCC) provided similar counseling supplemented by feedback to the smoker's health care team and help for the smoker in obtaining pharmacotherapy. At 6 months post-hospitalization, persistent smokers were re-engaged with either CCC or C.

Main measures: Utilization of pharmacotherapy and smoking cessation at 3, 6, and 12 months post-discharge.

Key results: Among 606 smokers randomized, 429 (70.8%) completed the 12-month assessment and 580 (95.7%) were included in the primary analysis. Use of any cessation pharmacotherapy between 0 and 6 months (55.2%) and between 6 and 12 months (47.1%) post-discharge was similar across treatment arms though use of prescription-only pharmacotherapy between months 6-12 was significantly higher in the CCC group (30.1%) compared with the C group (18.6%) (RR, 1.61 (95% CI, 1.08, 2.41)). Self-reported abstinence rates of 26.2%, 20.3%, and 23.4% at months 3, 6, and 12, respectively, were comparable across the two treatment arms. Of those smoking at month 6, 12.5% reported abstinence at month 12. Validated smoking cessation at 12 months was 19.3% versus 16.9% in the CCC and C groups, respectively (RR, 1.13 (95% CI, 0.80, 1.61)).

Conclusion: Supplemental care coordination, provided by counselors outside of the health care team, failed to improve smoking cessation beyond that achieved by cessation counseling alone. Re-engagement of smokers 6 months post-discharge can lead to new quitters, at which time care coordination might facilitate use of prescription medications.

Trial registration: NCT01063972.

Keywords: care coordination; smoking cessation; transition of care.

Conflict of interest statement

Drs. Ellerbeck, Cox, Hui, Keighley, Hutcheson, Cupertiono, Greiner, Miller, Rabius, and Richter and Ms. Fitzgerald report grants from the National Institutes of Health during the conduct of the study.

Dr. Rigotti reports grants from NCI, during the conduct of the study; personal fees from UpToDate, Inc.; personal fees from Achieve Life Sciences; and grants and non-financial support from Pfizer, outside the submitted work.

Figures

Figure 1

CONSORT diagram. Deceased, incarcerated, and withdrew consent are reported cumulatively. Deceased and incarcerated were removed from analyses.aIneligible categories are not mutually exclusive.bDischarge facilities were primarily nursing homes, but also included incarceration and alcohol or drug rehabilitation.c“Other” includes prolonged hospital stay, under 18 years of age, emergency room visit only, and already enrolled.