Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network

Background Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. Objective To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters. Design 3-arm pragmatic randomized controlled trial. Participants Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record ( n = 5225) and recruited using automated phone calls. Interventions One intervention group involved engagement with a health system–based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral). Measurements Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment. Key Results Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p