Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center
Open accessAbstract
Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervising physician/prescriber, affords an opportunity to integrate more intensive tobacco dependence treatment into hospitals, clinics, and other medical systems. This article analyzes treatment outcomes and predictors of abstinence for cigarette smokers being treated using the TTS-physician team in a large outpatient clinic over a 7-year period.This is an observational study of a large cohort of cigarette smokers treated for tobacco dependence at a medical center. Patients referred by the primary healthcare team for a TTS consult received a standard assessment and personalized treatment planning guided by a workbook. Medication and behavioral plans were developed collaboratively with each patient. Six months after the initial assessment, a telephone call was made to ascertain a 7-day period of self-reported abstinence. The univariate association of each baseline patient characteristic with self-reported tobacco abstinence at 6 months was evaluated using the chi-squared test. In addition, a multiple logistic regression analysis was performed with self-reported tobacco abstinence as the dependent variable and all baseline characteristics included as explanatory variables.Over a period of 7 years (2005-2011), 6824 cigarette smokers who provided general research authorization were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95% confidence interval: 27.7-30.1). The patients most likely to report abstinence were less dependent, more motivated to quit, and did not have a past year diagnosis of depression or alcoholism.Predictable patient characteristics such as level of dependence did predict abstinence, but all patient groups achieved comparable abstinence outcomes. While this study has limitations inherent in a single-center retrospective cohort study, it does suggest that the TTS model is an effective way to integrate more intensive tobacco dependence treatment into outpatient settings.
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The clinic's 1-year abstinence rate (38%) is higher than that of UK stop smoking services (~8%) and the Mayo clinic (28% at 6 months).
“These are very high success rates compared for example with around 8% achieved in UK stop smoking services [25] (which also deliver a combination of behavioural support and pharmacotherapy, albeit usually restricted to a shorter period of time ) and compared with the Mayo clinic which uses a similar treatment model and reported 28% self-reported abstinence at 6 months [26].”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [26]
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- Authors
- Burke, M. V., Ebbert, J. O., Schroeder, D. R., McFadden, D. D., & Hays, J. T.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Burke, Michael V.
- Venue
- Medicine
- Published
- 2015-11
- Volume
- 94
- Issue
- 44
- Pages
- e1903
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC4915890
- OpenAlex
- W2329939972
- Cited by
- 13
- References
- 33
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 1
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- tobacco use disorder, smoking cessation, tobacco dependence treatment, behavioral interventions, medication-assisted treatment, predictors of abstinence, motivation to quit, depression, alcoholism, outpatient clinics
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Tobacco Use Disorder, Smoking Cessation, Treatment Outcome, Young Adult, Tobacco Use Cessation Devices
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