BACKGROUND

1. Proactive Telephone Smoking Cessation Treatment in a VA Mental Health Population: Preliminary Treatment Engagement and Cessation Outcomes Erin Rogers, MPH1,David Smelson, PsyD2,3,Senaida Fernandez, PhD1, Colleen Gillespie, PhD4, Alfredo Axtmayer1,Scott Sherman, MD, MPH1,4 (1) VA New York Harbor Healthcare System (2) Bedford VA Medical Center (3) University of Massachusetts Medical School (4) New York University School of Medicine RESULTS RESULTS BACKGROUND • About 50% of VA patients with a mental health (MH) diagnosis use tobacco. • MH patients are interested in quitting but face many barriers. • We evaluated the implementation of a proactive telephone care program for smokers using VA MH clinics. • Primary outcomes were program reach, treatment engagement and long-term abstinence. 6-month Abstinence Referrals • Abstinence rates are excellent and comparable across groups (32% vs. 28%, OR=1.16, 95% CI 0.57-2.35) TELEPHONE PROGRAM • Convenient program design for providers and patients. • MH providers refer smoking patients via quick EMR consult during routine care. • Referred patients contacted by phone and offered: • mailed self-help materials • smoking cessation medications (NRT or bupropion) • multi-call telephone counseling. • Participants randomized to receive counseling from state Quitline or a VA counselor with specialized training on smokers with mental illness. CONCLUSIONS & IMPACT • Initial interest and support for the program from MH providers was high at all sites. • Program reach much lower than expected and differs by site (1-9% of MH pop.). Most sites could not increase referrals from MH providers despite steady marketing. • Among MH patients referred to the program, the program has been effective at reaching and engaging them into treatment. • Long-term abstinence rates are excellent and similar in VA Counseling and Quitline Counseling arms. • Future research should identify ways to increase tobacco cessation treatment referrals from MH providers. STUDY METHODS Treatment Engagement • Program implemented at 5VA sites over 2 years. • MH providers were informed of the program and received feedback via regular email and presentations. • Telephone assessment at 6-mo to assess 30-day point prevalence abstinence by self-report. Patients not interested in treatment had option of enrolling in follow-up calls only. • Results presented are preliminary (first 873 referrals). • 77% of referred patients are reached by phone to offer treatment. • 67% of patients reached by the program enroll in treatment. • 100% interested in counseling; 88% interested in medications. • Participants were equally likely to begin VA and Quitline counseling (70% vs 74%, OR = 0.80, 95% CI = .049-1.28). ACKNOWLEDGEMENTS This study was funded by the VA HSR&D QUERI (Project # SDP07-034).