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Quitlink : A Leveraging Solution to Tobacco Counseling

Phase 3
18 Years
Not Enrolling

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Trial Information

Quitlink : A Leveraging Solution to Tobacco Counseling

Among the most important evidence-based interventions in primary care is to offer counseling
and pharmacotherapy to patients who use tobacco, but studies suggest that only a fraction of
tobacco users receive this assistance. Office systems and other strategies can improve
counseling rates but are not widely adoptable in primary care. We propose a novel solution
that couples a simple office system, which is widely adoptable, with a form of third-party
counseling (telephone quit lines) that most practices can access in the United States.
Specifically, the three-part intervention includes (1) an in-office expanded “vital signs”
intervention that prompts nurses (or medical assistants) to determine tobacco use status,
offer brief advice, and assess readiness to quit as vital signs are obtained; (2) inviting
preparation-stage tobacco users to obtain proactive telephone counseling (provided by the
American Cancer Society) comprising three 30-minute sessions scheduled at the patient’s
convenience; and (3) feedback from the Society to the practice, including fax requisitions
for prescription aids for quit attempts, progress reports on the results of counseling, and
quarterly aggregate analyses of practice and clinician team referral outcomes. The Virginia
Ambulatory Care Outcomes Research Network will partner with the American Cancer Society to
test this strategy in a randomized controlled trial conducted at 16 primary care practices
in Virginia. Because existing dissemination strategies serve mainly to increase
identification of tobacco users and sometimes to increase brief advice, our primary outcome
measure will be the proportion of tobacco users who receive substantive assistance: Assess,
Assist, and Arrange of the 5As. Given the widening availability of state and national quit
line programs, our model for referrals and bidirectional communication with primary care
could markedly augment the effectiveness of both primary care and quit lines in promoting
tobacco cessation and provide an attractive alternative for clinicians who lack the time and
resources to provide effective counseling.

Inclusion Criteria:

- Current use of tobacco

- Age 18 or older

- Visit with a clinician that day

- Patient at one of the 16 practices in the study

Exclusion Criteria:

- Unable to participate in a self-administered exit survey

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Educational/Counseling/Training

Outcome Measure:

Whether the intervention increases the proportion of tobacco users (age 18 and older) who receive help within the domains of A3-5 (Assess, Assist, and/or Arrange) at the index office visit, as reported by exiting patients


United States: Institutional Review Board

Study ID:




Start Date:

June 2005

Completion Date:

July 2006

Related Keywords:

  • Smoking
  • randomized controlled trial
  • primary health care
  • smoking cessation
  • Smoking



Virginia Ambulatory Care Outcomes Network (ACORN) Richmond, Virginia  23298-0251