The Providence Health System (PHS) in Oregon is an individual practice association model health maintenance organisation with more than 300 000 covered lives in our capitated model and more than 360 000 members in our preferred provider model, which is a discounted fee for service structure. PHS has 12 000 employees, over 1400 acute and long term beds, and a demonstrated commitment to social accountability. Tobacco cessation programs are one of the top priorities for reducing overall cardiac morbidity and mortality. A regional health system task force for tobacco cessation comprised of key personnel and stakeholders was formed in 1994 (table 1). The physician leader's role was to educate medical care providers on smoking cessation, while the program development administrator helped coordinate activities and was instrumental in securing funds for all initiatives. Health education played a critical role in administration of the intensive cessation interventions and other member focused interventions. Health plan involvement was important in changing the benefit structure of the health plan to broaden coverage for smoking cessation programs. Pharmacy input was needed with the advent of several new pharmaceutical tobacco cessation interventions.

The PHS smoking cessation task force developed a multifaceted approach to tobacco cessation (fig 1). The overall program starts with a variety of cessation services offered to our patients. The group support program is a 10 session behaviour modification class. The telephone support program (“Free & Clear”, Group Health Cooperative, Puget Sound) is provided to members. The individual support intervention (one on one), for highly comorbid patients who have failed group support, consists of individual counselling with a highly trained smoking cessation counsellor for 12 months. The task force developed self help materials in Spanish and Russian. We have a pharmacotherapy benefit for the over the counter nicotine patch and …