QuitWorks' Evidence Base

• Tools to identify smokers
• Prompts to guide providers to intervene with smokers and offer pharmacotherapy
• Proactive telephone counseling > 30 minutes for smokers
• Patient education materials
• Feedback reports to providers

 Systematic Identification of Smokers
Adopting office systems to identify smokers and to prompt providers to intervene increases the delivery of tobacco treatment by clinicians. Based on a meta-analysis of studies evaluating the efficacy of office systems to identify smokers at each clinical encounter, the use of a screening system to identify smoking status was found to increase cessation rates. QuitWorks provides tools needed to implement office-wide systems to ensure that, for every patient at every clinic visit, tobacco-use status is queried and documented.

 Brief Clinician Interventions
Clinical trials clearly demonstrate that brief smoking cessation counseling by physicians, dentists, and other clinicians significantly increases smoking cessation rates in adult patients. Utilizing evidence determined from these trials, the U.S. Public Health Service published in 2000 a clinical practice guideline for treating nicotine dependence, Treating Tobacco Use and Dependence.
Known as the 5A's Intervention, these guidelines recommend that the clinician:

• ASK about tobacco use at each visit
• ADVISE all tobacco users to stop
• ASSESS desire and willingness to quit
• ASSIST patients in quitting
• ARRANGE follow-up to support and reinforce patient efforts

 
 Behavioral Counseling and Pharmacotherapy
The evidence supporting the guidelines showed that brief physician advice to quit improved patient cessation rates, and the addition of brief counseling (under three minutes) increased the cessation rates even more.

Behavioral counseling (including telephone-based services) and pharmacotherapy (nicotine gum, patch, nasal spray, lozenge and inhaler) or the antidepressant bupropion (Zyban® or Wellbutrin SR®) were found to be effective. A combination of counseling and pharmacotherapy produced the best results. Physician or clinician advice based on health issues provides a strong incentive for smokers to quit. QuitWorks reinforces and enhances clinician efforts and supports successful quit attempts.

 Telephone Counseling Works
The Public Health Service Clinical Practice Guidelines recommends proactive telephone counseling, as treatments involving person-to-person contact (individual, group, or proactive telephone counseling) are consistently effective.
QuitWorks Results

 Who Uses QuitWorks
From the start of the QuitWorks program in April 2002, over 18,000 patients were referred to the QuitWorks program. The following is a snapshot of the patient profile for QuitWorks participants:

• 60% are women;
• 60% report smoking within 15 minutes of waking (a sign of high addiction level);
• 57% indicate that they are ready to quit smoking in 30 days;
• 47% have a high school education or less;
• 46% are 45-64 years old;
• 38% are 25-44 years old;
• 29% are not interested in quitting or making a plan to quit within 30 days; and
• 15% are ethnic minorities.

 
 QuitWorks Patient Outcomes
Starting in November of 2003, all QuitWorks patients who complete an intake with the QuitWorks counselor receive a 6-month follow-up evaluation call from the Survey Team at John Snow, Inc. If reached, each patient participates in a brief interview to ascertain a) whether or not they had quit smoking, b) the number and duration of quit attempts made, c) services used which were provided by the Resource Center or which clients may have secured on their own, d) which services helped clients to quit smoking (including the use of nicotine replacement therapy) and e) client's level of satisfaction with services delivered by the Massachusetts Smokers' Helpline and the their referring provider.

The Helpline offers counseling and web resources in addition to mailing clients self-help materials to assist them in their quit smoking attempts and maintenance of a quit with the following results:

• 90% are satisfied with the services and assistance received both from the Helpline and from the health care provider who enrolled them in the program;
• 86% said their health care provider increased their level of motivation to quit, thus reinforcing the significance of the provider-patient relationship in the successful quit smoking process;
• 76% use some combination of the Helpline services;
• 52% used some form of Nicotine Replacement Therapy (NRT) to assist them with their quit attempt;
• 21% indicated they were currently quit for at least 7 days; and
• 19% were currently quit for at least 30 days.