This planning project tested whether physicians would be more likely to adhere to the AHCPR smoking cessation guidelines if the "assistance" and "arrange follow-up" steps could be delegated to a centralized smoking cessation telephone resource.

Three managed care organizations in Vermont each selected a clinic to participate in the study. Baseline provider adherence to the AHCPR guidelines was assessed by patient exit interviews at each clinic. The smoking cessation telephone resource and corresponding office systems were then designed with the providers and office staff. Patients who accepted referral to the resource were called by the American Lung Association of Vermont and offered interventions. Providers were faxed a referral response with a summary of the patient's status, interventions initiated, and recommended pharmacotherapy interventions that the provider would initiate. Patients could be referred to the resource regardless of insurance. The cost of the pilot resource was supported by the three managed care organizations. After four months of resource operation, post intervention adherence to the AHCPR guidelines was assessed by exit interviews.

The smoking cessation telephone resource had 209 patient referrals over the four-month study period. Post-intervention, rates of asking and advising were not significantly different from baseline. While the proportion of patients who were offered assistance increased, the results were not statistically significant. The increase in the proportion of patients for whom follow-up was arranged was statistically significant (p < 0.02).

A smoking cessation telephone resource is feasible and acceptable to a large proportion of patients who smoke. Additionally, providers will refer patients to such a resource. However, the resource must be accessible; the telephone resource was not available in the evening, which was a significant limitation. Further research is warranted to determine the true impact of the availability of such a resource on provider adherence to the AHCPR guidelines.