Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network

Abstract

Background: Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. Objective: To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters. Design: 3-arm pragmatic randomized controlled trial. Participants: Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls. Interventions: One intervention group involved engagement with a health system–based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral). Measurements: Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment. Key Results: Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p < 0.001), cessation medication prescription (52% vs. 30%, p = 0.002), and counseling (47% vs. 9%, p < 0.001). Internal care coordination was more effective than external community referral at connecting smokers to any cessation treatment (76% vs. 50%, p = 0.001) and at providing cessation medication (66% vs. 39%, p < 0.001), but comparable at linking smokers to cessation counseling resources. Conclusions: Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system–based or community-based program compared with usual care. The health system–based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates. Trial Registration: ClinicalTrials.gov NCT03612895.