Tell a Colleague

QuitWorks-NH offers five proven elements recommended in the U.S. Public Health Service-sponsored Clinical Practice Guideline: Treating Tobacco Use and Dependence and in the CDC-sponsored Guide to Community Preventive Services (see Related Resources below):

1. Tools to identify smokers
2. Prompts to guide providers to intervene with smokers and offer pharmacotherapy
3. Proactive telephone counseling for smokers > 30 minutes
4. Patient education materials
5. 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. The QuitWorks-NH Materials provide 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.

Behavioral Counseling and Pharmacotherapy

The evidence supporting the guideline 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), the antidepressant bupropion (Zyban® or Wellbutrin SR®) or the nicotine receptor agonist varenicline (Chantix™) 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-NH reinforces and enhances clinician efforts and supports successful quit attempts.

Telephone Counseling Works

The Public Health Service Clinical Practice Guideline recommends proactive telephone counseling, as treatments involving person-to-person contact (individual, group, or proactive telephone counseling) are consistently effective.

Who Uses QuitWorks - The Massachusetts Experience

From the start of the QuitWorks program in April 2002 to March 2005, over 6,000 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-NH Patient Outcomes

All QuitWorks-NH patients who complete an intake with the QuitWorks-NH 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 Helpline of the Try-To-STOP TOBACCO Resource Center and 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.