Efficacy of Ask Advise Connect in a Safety Net Healthcare System

Details

• Alternative Title:
  Am J Prev Med
• Personal Author:
  Vidrine, Jennifer Irvin ; Shete, Sanjay ; Li, Yisheng ; Cao, Yumei ; Alford, Margo Hilliard ; Galindo-Talton, Michelle ; Rabius, Vance ; Sharp, Barry ; Harmonson, Penny ; Zbikowski, Susan M. ; Miles, Lyndsay ; Wetter, David W.
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• Description:
  Background ; Since smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The US Public Health Service recommends that all patients be asked about their smoking at every visit, and that smokers be given brief advice to quit and referred to treatment. ; Purpose ; Initiatives to facilitate these practices include the 5 A’s (i.e., Ask, Advise, Assess, Assist, Arrange) and Ask Advise Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask Advise Connect (AAC) approach to linking smokers with treatment in a large, safety-net public healthcare system. ; Design ; Pair-matched-two-treatment arm group-randomized trial. ; Setting/participants ; Ten safety-net clinics in Houston, TX. ; Intervention ; Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed Vocational Nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record (EHR). Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas Quitline daily, and patients were proactively called within 48 hours. In AAR, smokers were offered a Quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. ; Main Outcome Measure ; The primary outcome – impact – was defined as the proportion of identified smokers that enrolled in treatment. ; Results ; The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t (4) = 14.61, p = 0.0001, OR = 32.10 (95% CI 16.60–62.06). ; Conclusions ; AAC has tremendous potential to reduce tobacco-related health disparities.
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• Keywords:
  • Electronic Health Records
  • Health Status Disparities
  • Hotlines
  • Humans
  • Referral and Consultation
  • Safety-net Providers
  • Smoking
  • Smoking Cessation
  • Smoking Prevention
  • Socioeconomic Factors
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• Source:
  Am J Prev Med. 45(6):737-741
• Pubmed ID:
  24237916
• Pubmed Central ID:
  PMC4023543
• Document Type:
  Journal Article
• Funding:
  P30 CA016672/CA/NCI NIH HHSUnited States/ ; R18 DP001570/DP/NCCDPHP CDC HHSUnited States/ ; CA016672/CA/NCI NIH HHSUnited States/ ; R18DP001570/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  45
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/29959/cdc_29959_DS1.pdf
• File Type:
  [PDF - 782.93 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ffdb25ef7ef44223ecd0e78681a9f888206271a574b73b7cc6f57f2f94fb877f