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Chronic disease management for tobacco dependence: a randomized, controlled trial.
Anne M Joseph1, Steven S Fu, Bruce Lindgren
1Department of Medicine, University of Minnesota, Minneapolis, 55414, USA. amjoseph@umn.edu
Archives of Internal Medicine
|November 30, 2011
Summary
Longitudinal care management significantly improved long-term smoking abstinence rates compared to usual care. This chronic disease management approach supports repeat quit attempts and smoking reduction for tobacco dependence.
Area of Science:
- Public Health
- Behavioral Science
- Clinical Medicine
Background:
- Tobacco dependence is a chronic, relapsing condition with suboptimal long-term cessation rates using episodic care.
- Current treatments often yield disappointing results for sustained smoking abstinence.
Purpose of the Study:
- To compare the efficacy of telephone-based chronic disease management (longitudinal care [LC]) versus standard evidence-based treatment (usual care [UC]) for tobacco dependence.
- To evaluate long-term smoking abstinence rates at 18 months post-intervention.
Main Methods:
- A randomized controlled trial involving 443 smokers from June 2004 to May 2009.
- Participants received initial counseling and nicotine replacement therapy, then were randomized to 8 weeks (UC) or 52 weeks (LC) of continued care.
- The primary outcome was 6 months of prolonged abstinence, measured at 18 months.
Main Results:
- Longitudinal care (LC) resulted in 30.2% prolonged abstinence at 18 months, versus 23.5% for usual care (UC) (P = .13).
- Multivariate analysis indicated LC significantly predicted prolonged abstinence (adjusted odds ratio, 1.74).
- LC participants received substantially more counseling and nicotine replacement therapy than UC participants.
Conclusions:
- A chronic disease management model effectively increases both short- and long-term smoking abstinence.
- This approach supports sustained smoking cessation for individuals with tobacco dependence disorder.
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