Adding telephone calls to standard care increases smoking cessation rates, according to the results of a prospective, randomized study reported in the March 13 issue of the Archives of Internal Medicine.

"Brief clinician intervention and telephone counseling are both effective aids for smoking cessation," write Lawrence C. An, MD, from the University of Minnesota in Minneapolis, and colleagues. "However, the potential benefit of telephone care above and beyond routine clinician intervention has not been examined previously."

In this study, 837 daily smokers from 5 Veterans Affairs medical centers in the upper Midwest were randomized to receive telephone care (n = 417) or standard care (n = 420). The former group received behavioral counseling with mailing of smoking cessation medications as clinically indicated, and the standard-care group received intervention as part of routine healthcare. The main end point was 6-month duration of abstinence by self-report 12 months after enrollment. Secondary end points were 7-day point-prevalence abstinence at 3 and 12 months, participation in counseling programs, and use of smoking cessation medications.

Intention-to-treat analysis revealed that the rate of 6-month abstinence at the 12-month follow-up was 13.0% in the telephone care group and 4.1% in the standard-care group (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.99 - 6.15). At 3 months, the rate of 7-day point-prevalence abstinence was 39.6% in the telephone-care group and 10.1% in the standard-care group (OR, 5.84; 95% CI, 4.02 - 8.50). Compared with standard care, telephone care increased the rates of participation in counseling programs (97.1% vs 24.0%; OR, 96.22; 95% CI, 52.57 - 176.11) and use of smoking cessation medications (89.6% vs 52.3%; OR, 7.85; 95% CI, 5.34 - 11.53).

"Telephone care increases the use of behavioral and pharmacologic assistance and leads to higher smoking cessation rates compared with routine health care provider intervention," the authors write.

Study limitations include lack of biochemical validation of smoking status; population predominantly male, elderly, and with multiple medical problems and extensive smoking histories; and inability to separate the effects of behavioral and pharmacologic therapy.

"At a minimum, telephone care for smoking cessation should be made available to veterans who are interested in stopping smoking," the authors write. "The findings of this study lend additional support to the recommendation for a national network of quitlines that would make these services available to all tobacco users in this country."

The Department of Veterans Affairs (VA) Health Services Research and Development Service funded this study. The authors report no financial conflicts of interest.