Patient referral to a smoking cessation program: who follows through?

While health care providers are often urged to refer smokers to a smoking cessation program, little information is available about patient adherence to such advice.

A group of primary care patients who smoked (N = 1380) received brief advice to quit from their provider, and were then asked to stay and talk to a counselor for more information. Counselors randomly delivered one of two interventions. For the intervention group, referral to a specific group cessation program was emphasized, and for the control group, quitting advice was merely repeated. The referral intervention included a video in which role models testified to the acceptability and usefulness of the HMO's group program. The usual program fees were waived, and patients received a supportive, follow-up telephone call 1 week after their visit.

In the referral intervention group, 53.2% of patients agreed to go to the cessation program and 11.3% actually attended, compared with only .006% of the patients who received advice only. Logistic regression analyses revealed that patients who were contemplating quitting were more than five times as likely to respond to the referral compared to precontemplators (smokers who were not seriously considering quitting). Older, heavier smokers were also more likely to attend a group session.

An intensive, specific referral to a group smoking cessation program can increase participation by patients. Most patients, however, will not attend a group program; therefore, a brief office-based intervention for all smokers should precede referral.