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13.06.2019 | Original Research | Ausgabe 8/2019

Journal of General Internal Medicine 8/2019

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

Journal of General Internal Medicine > Ausgabe 8/2019
MD, MAS Sara Kalkhoran, BA Elizabeth M. Inman, RN, MA Jennifer H. K. Kelley, PhD, MPH Jeffrey M. Ashburner, MD Nancy A. Rigotti
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05079-3) contains supplementary material, which is available to authorized users.
This study was presented at the 2018 Society for General Internal Medicine Annual Meeting in Denver, CO.

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Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters.


To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters.


3-arm pragmatic randomized controlled trial.


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.


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).


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.


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.

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