Proactive outreach for smokers using VHA mental health clinics

Protocol for a patient-randomized clinical trial

Erin S. Rogers, Steven S. Fu, Paul Krebs, Siamak Noorbaloochi, Sean M. Nugent, Radha Rao, Carolyn Schlede, Scott Sherman

Research output: Contribution to journalArticle

Abstract

Background: Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design: We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion: Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration: Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).

Original languageEnglish (US)
Article number1294
JournalBMC Public Health
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Veterans Health
United States Department of Veterans Affairs
Telephone
Mental Health
Randomized Controlled Trials
Tobacco
Counseling
Mentally Ill Persons
Tobacco Use
Therapeutics
Tobacco Use Cessation
Cotinine
Tobacco Use Disorder
Electronic Health Records
Ambulatory Care
Nicotine
Saliva
Referral and Consultation
Smoking
History

Keywords

  • Mental health
  • Smoking
  • Smoking cessation
  • Tobacco

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Proactive outreach for smokers using VHA mental health clinics : Protocol for a patient-randomized clinical trial. / Rogers, Erin S.; Fu, Steven S.; Krebs, Paul; Noorbaloochi, Siamak; Nugent, Sean M.; Rao, Radha; Schlede, Carolyn; Sherman, Scott.

In: BMC Public Health, Vol. 14, No. 1, 1294, 01.01.2014.

Research output: Contribution to journalArticle

Rogers, Erin S. ; Fu, Steven S. ; Krebs, Paul ; Noorbaloochi, Siamak ; Nugent, Sean M. ; Rao, Radha ; Schlede, Carolyn ; Sherman, Scott. / Proactive outreach for smokers using VHA mental health clinics : Protocol for a patient-randomized clinical trial. In: BMC Public Health. 2014 ; Vol. 14, No. 1.
@article{e3360508bd914bc9aa169fddfced55cb,
title = "Proactive outreach for smokers using VHA mental health clinics: Protocol for a patient-randomized clinical trial",
abstract = "Background: Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design: We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion: Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration: Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).",
keywords = "Mental health, Smoking, Smoking cessation, Tobacco",
author = "Rogers, {Erin S.} and Fu, {Steven S.} and Paul Krebs and Siamak Noorbaloochi and Nugent, {Sean M.} and Radha Rao and Carolyn Schlede and Scott Sherman",
year = "2014",
month = "1",
day = "1",
doi = "10.1186/1471-2458-14-1294",
language = "English (US)",
volume = "14",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Proactive outreach for smokers using VHA mental health clinics

T2 - Protocol for a patient-randomized clinical trial

AU - Rogers, Erin S.

AU - Fu, Steven S.

AU - Krebs, Paul

AU - Noorbaloochi, Siamak

AU - Nugent, Sean M.

AU - Rao, Radha

AU - Schlede, Carolyn

AU - Sherman, Scott

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design: We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion: Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration: Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).

AB - Background: Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design: We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion: Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration: Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).

KW - Mental health

KW - Smoking

KW - Smoking cessation

KW - Tobacco

UR - http://www.scopus.com/inward/record.url?scp=84924328386&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924328386&partnerID=8YFLogxK

U2 - 10.1186/1471-2458-14-1294

DO - 10.1186/1471-2458-14-1294

M3 - Article

VL - 14

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 1294

ER -