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Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models
  1. Scott E Sherman1,2,
  2. Paul Krebs1,2,
  3. Laura S York3,
  4. Sharon E Cummins4,
  5. Ware Kuschner5,6,
  6. Sebnem Guvenc-Tuncturk7,
  7. Shu-Hong Zhu4
  1. 1 VA NY Harbor Healthcare System, New York, New York, USA
  2. 2 Department of Population Health, New York University School of Medicine, New York, New York, USA
  3. 3 Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
  4. 4 Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
  5. 5 VA Palo Alto Healthcare System, Palo Alto, California, USA
  6. 6 Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
  7. 7 Department of Pulmonary and Critical Care Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
  1. Correspondence to Dr Paul Krebs, Department of Population Health, New York University School of Medicine, 227 East 30th St, New York, NY 10016, USA; paul.krebs{at}


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.

  • Tobacco cessation
  • quitline
  • veterans
  • proactive

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  • Contributors SS conceived the study and supervised the implementation; PK led the writing of results and analysis; LY served as the project manager and data co-ordinator; SC and WK contributed to project conception and intervention design; SGT led the implementation of the intervention; SHZ led the data analysis.

  • Funding This work was supported by VA HSR&D grant number #IMV 04–088.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.