Showing papers on "Referral published in 1992"

Primary Care: Concept, Evaluation, and Policy

Abstract: Section I: Primary Care: Concept and Goals. 1: What is primary care?. 2: A basis for evaluating primary care. Section II: Elements of Primary Care. 3: First contact care and gatekeepers. 4: Longitudinality and managed care. 5: Comprehensiveness and benefit packages. 6: Coordination and the processes of referral. Section III: Primary Care in the United States. 7: Characteristics of practice and practitioners. 8: Organization, financing, and access to services. Section IV: Issues in Primary Care. 9: What type of physicians should provide primary care. 10: Medical records and information systems in primary care. 11: Physician-patient interactionsin primary care. 12: Quality assessment and quality improvement. 13: Community oriented primary care. Section V: Primary Care Systems. 14: Evaluation of primary care programs. 15: Cross-national comparisons of primary care. 16: A research agenda. 17: A policy agenda and epilogue

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

Abstract: The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother9s ethnicity, age, or education or with child9s birth weight, gender, or neonatal health status; but they were positively related to children9s IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ ≤70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.

Effects of public and professional education on reducing the delay in presentation and referral of stroke patients.

Abstract: Several emerging stroke therapies require patients to be treated within several hours of symptom onset. Past studies have documented a significant delay between symptom onset and hospital presentat...

Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment?

Abstract: ▪Objective:To determine whether a gender bias exists in referral for coronary bypass graft surgery among patients with catheterization-documented coronary artery disease. ▪Design:Historica...

Can health visitors prevent fractures in elderly people

Abstract: OBJECTIVES--To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over DESIGN--Randomised, controlled trial; randomisation by household SETTING--General practice in a market town SUBJECTS--Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls INTERVENTION--The people in the intervention group were allocated to the care of a health visitor The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit The intervention continued for four years MAIN OUTCOME MEASURE--Fracture rate over four years RESULTS--The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant) CONCLUSIONS--A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures

Prediction of children's referral to mental health and special education services from earlier adjustment.

Abstract: markdown The 4-year stability in problem behaviors assessed with the Child Behavior Checklist (CBCL), and their predictive validity with regard to poor outcome variables was studied in 1052 4–12–year old children from a general population sample. Irrespective of sex and age, the scores on [he CBCL of some 44% of the children remained above the 90th percentile over the 4-year time interval. Externalizing problem behavior tended to show somewhat greater stability than internalizing problem behavior. High initial levels of both internalizing and externalizing problems, and persistence of problems were predictive of referral to mental health services. Referral to special education was higher for younger boys with high initial attention problems and school problems. Police contacts occurred more often in older boys with high initial aggression scores.

A study of race and gender bias in the punishment of school children.

Abstract: The purpose of the present study was to assess race and gender differences in the occurrence and treatment of school children's (a) rates of referral for disciplinary action, (b) types of rule violations, and (c) types of punishments administered for those violations. The sample consisted of 4,391 discipline files, representing all pupils (Grades K through 12) receiving disciplinary action in a nine-school south Florida school district between August 1987 and April 1988. The following data were collected from each disciplinary record: school, grade, race, age, gender, nature of rule violation, frequency of referrals, disciplinary actions taken, and follow-up actions taken. All data were analyzed using an SPSS computer program for the chi-square. Seven categories of misbehavior accounted for 80.5% of all rule violations. Males represented over three-fourths of all discipline referrals. Black pupils received more corporal punishment and were suspended from school more frequently; white pupils received more in-school suspensions. Black pupils had higher referral rates, disproportionate to both their percentages of school enrollment and rates of disciplinary recidivism. The results are discussed in terms of the changing nature of schools in the United States. Language: en

Results of a Randomized Trial of Partner Notification in Cases of HIV Infection in North Carolina

Abstract: Background We sought to compare two methods of notifying sex partners of subjects infected with the human immunodeficiency virus (HIV) or persons who had shared needles with them (needle-sharing partners): "patient referral," in which the responsibility for notifying partners was left to the patient, and "provider referral," in which providers attempted to notify partners. Methods Names of sex partners and needle-sharing partners and information on how to locate them were obtained from consenting HIV-infected subjects identified in the HIV-testing programs at three public health departments in North Carolina. The subjects were randomly assigned to a patient-referral group (in which patients had the initial responsibility for notifying their partners) or a provider-referral group (in which the study counselor notified the partners). The success of attempts to notify partners was monitored by means of interviews with counselors conducted both in the field and at the health department. Results Of 53...

Can the poor afford ‘free’ health services? A case study of Tanzania

Abstract: This research was concerned with the feasibility of government charges for health services. The aim was to test the validity of charging individuals not using special facilities and to determine acceptable and equitable charges for specified services. Surveys were conducted for: 1) 29518 prescriptions dispensed at 28 health units in 7 different regions; 2) 892 outpatients at 3 referral hospitals 2 regional hospitals and 4 district hospitals; and 3) 1820 households in 3 urban cities or in locations between mission and government hospitals in 26 rural districts and 15 regions. Current medical services reach 93% of the population within 10 km and 72% within 5 km. Health services are free except for charges for patients in special or private wards at referral and regional hospitals for dental appointments and for immunization for travel. Public expenditure has been declining and there is underfinancing for drugs medical equipment and vehicles building maintenance salaries support staff and an information system. Findings are presented for hospital waiting timetravel costs choices of facilities (traditional services mission services and government services) costs admissions and costs reasons for choice of services willingness to pay improvements desired financial constraints and rationale for charges. The justification for government charges stems from concerns about frivolous use the presence of charges at mission facilities and improvements to services. It is argued that long waiting lines are sufficient to stop frivolous use. Patients used missions because of access to drugs. Government services were used because of inexpense and convenience. Most were willing to pay for services at hospitals if there were improvements in drug and food availability for instance; i.e. about 50% would pay Tsh 200 (Tanzanian shillings) at referral and regional hospitals and Tsh 100 at district hospitals. Waiting times could be 3-4 hours. 84% of rural patients and 55% of urban patients walked to facilities. Travel costs were Tsh 673 at the lowest and Tsh 4741 at the highest; the mean cost for a consultation was Tsh 440. 59% in the outpatient survey were willing to pay Tsh 200.

Communication between general practitioners and consultants: what should their letters contain?

Abstract: OBJECTIVE--To canvass the views of all general practitioners and consultants working in Newcastle upon Tyne on the content of referral letters and replies, the feasibility of standardising certain aspects of referral letters, and the use of communications data for audit purposes. DESIGN--A postal questionnaire was sent to all general practitioners and consultants in Newcastle upon Tyne in May 1991. Questions were asked about the clinical and administrative content of letters, the utility of standard categories to state the reason for referral, the idea of using letters for feedback purposes, and communications as a potential topic for professionally led audit. SETTING--Area served by Newcastle upon Tyne Family Health Services Authority and District Health Authority. RESULTS--Replies were received from 274 (77%) doctors (115 general practitioners and 159 consultants). A majority (225; 82%) were in favour of items defined as "always important" forming a minimum requirement for referral letters and for consultants9 replies. Using standardised categories to state the reason for referral was not endorsed: 102 (89%) general practitioners and 132 (83%) consultants preferred referrers to use their own words. Using referral communications to provide feedback was less popular with consultants (54; 34%) than general practitioners (72; 63%). Finally, a majority of doctors (179; 65%) were in favour of using written communications as a topic for professionally led audit. CONCLUSIONS--A high degree of consensus exists among clinicians about the content of referral communications. Although doctors may still reject the concept of standardised communications, they have unambiguously endorsed a standard for communication that they can aspire to, and they are prepared to use it as a yardstick for their actual performance.

A Study of Race and Gender Bias in the Punishment of Handicapped School Children.

Abstract: There is scant research concerned about punishment of handicapped, minority students in public schools. The purpose of this study was to investigate race and gender, types of rules violations, types of punishments, referral rates, referral frequencies, and follow-up activities to determine differences in treatment by race, sex, and handicapping condition. The sample consisted of 4,391 discipline files representing records from 9 schools in a district (K-12). All data were analyzed using the Chi Square statistic. It was demonstrated that racial bias existed in the administration of punishment, and that Black, male handicapped students were punished more severely than others for commission of the same offenses.

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

Abstract: BACKGROUND 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 METHODS 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 RESULTS In the referral intervention group, 532% of patients agreed to go to the cessation program and 113% 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 CONCLUSIONS 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

Lower Threshold for Referral for Psychiatric Treatment for Adopted Adolescents

Abstract: Epidemiological data on a national sample of 3,698 adolescents, of whom 145 were adopted, indicate that adoption significantly increases the likelihood of referral for psychiatric treatment even after controlling for the fact that adoptees display more behavior problems and come from more educated families. This is accounted for by the fact that adoptees are significantly more likely to be referred when they display few problems. Thus, contrary to popular myth and clinical lore, the overrepresentation of young adoptees in clinical settings is not attributable solely to the fact that adoptees are more troubled. Rather, adoptees do display more problems but they are also referred more readily even after controlling for extent of problems.

Oral cancer diagnosis and delays in referral.

Abstract: Delays at various levels in the management pathway of oral cancer have previously been reviewed. It is a clinical impression that advanced tumours are being misdiagnosed by practitioners and consequently delays in referral are still prevalent. A study was conducted to compare the diagnosis and referral patterns of medical and dental practitioners. The results indicated that despite seeing similar populations of patients with oral cancer, the medical practitioner was better at diagnosing and referring cases early, and noting the relevance of lymphadenopathy. A high index of suspicion is a prerequisite for early diagnosis and referral of patients with oral cancer. The findings of this study highlight the importance of correct diagnosis, and support recent recommendations regarding practitioner education.

Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians.

Abstract: Background. There is widespread concern that ownership by physicians of testing or treatment facilities to which they refer patients leads to overuse of such facilities. We determined the patterns of use of three services — physical therapy, psychiatric evaluation, and magnetic resonance imaging (MRI) — among physicians treating patients whose care was covered under workers' compensation. We then compared the rates of use among physicians who referred patients to facilities of which they were owners (self-referral group) with the rates among physicians who referred patients to independent facilities (independent-referral group). Methods. We used a large data base to analyze claims under workers' compensation in California from October 1, 1990, through June 30, 1991, to determine the frequency and cost of these three selected services and determined whether the referring physicians were practicing self-referral or independent referral. We evaluated the cost per case for all three services, measure...

Randomized Trial of a Health Promotion Program for Frail Elders.

Abstract: This study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls (n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group (n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients (n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant (p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

Case management, quality of life, and satisfaction with services of long-term psychiatric patients.

Abstract: Two scales developed in Great Britain, the QOL Profile and the General Satisfaction Questionnaire, were used to examine the relationship between type of case management services and quality of life and satisfaction with treatment of 68 long-term psychiatric patients in Colorado. Factor analysis identified three types of case management activities that tended to occur together: assertive outreach (direct help, out-of-office visits, and monitoring), brokerage (referral to other agencies), and counseling and assessment. Monitoring was the only variable positively associated with quality of life for all patients; brokerage was the only variable negatively associated with acceptability of services. The number of case management contacts was negativtly associated with treatment satisfaction.

Referral patterns of patients with oral squamous cell carcinoma, Australia

Abstract: Early diagnosis is an important factor affecting the prognosis of patients with oral cancer. Delays in diagnosis have been variously reported as being linked to the patient, the clinician or both. The purpose of this study was to investigate the referral patterns of patients with oral cancer by medical and dental practitioners, in order to assess the delays in diagnosis and to establish the reasons for these delays. 51 consecutive patients diagnosed with oral mucous membrane squamous cell carcinoma were retrospectively reviewed. In this study it was found that over one-third of the patients (38%) delayed seeking professional advice for more than 3 months after first being aware of the lesion. Initial delays in diagnosis of oral cancer was identified in one-third of the cases (17 patients), with antimicrobial medications prescribed and denture adjustments constituting the most frequently administered inappropriate therapy. General medical practitioners were more likely to encounter and refer patients with more advanced (T4) primary oral cancers than their dental colleagues. The findings of this study raise the concern that lack of patient awareness and inappropriate clinical management prevails in a community that should be better informed.

Effectiveness of two palliative support teams.

Abstract: The palliative care of 227 consecutive patients by two support teams was measured according to 17 key indicators in the Support Team Assessment Schedule (STAS), an instrument previously developed and validated for use in these settings. Mean time in care was 71 days (range 1-547); 56 per cent of patients died at home, 26 per cent in hospital, 18 per cent in a hospice. Totalled ratings (sum of 15 items, excluding two items owing to missed ratings) improved in 83 per cent of cases, remained unchanged in 3 per cent and deteriorated in 13 per cent. The main problems which the STAS identified at referral were family anxiety, symptom control, patient anxiety and communication between patient and family. Fifteen of the 17 items showed significant improvements (Wilcoxon Z ranged from -3.18 to -8.20, p less than 0.00005) between referral ratings and ratings for the last week of the patient's life; family anxiety and spiritual needs did not. Patient anxiety and symptom control, although improved, also remained relatively severe at death. These results demonstrate the value of measuring key indicators and indicate areas where improvement in palliative care is needed.

Triage of patients out of the emergency department: Three-year experience

Abstract: Because of severe emergency department (ED) overcrowding, the authors initiated a program of referring certain patients who were assessed as not needing emergency care away from the ED. A selected group of patients who presented to a busy university ED were refused treatment and triaged away following a medical screening examination performed by a nurse. In this 3-year study 136,794 patients presented to the triage area in the ED, of which 21,069 (15%) were refused care and referred elsewhere. Letters and calls to all referral clinics, eight local EDs, and the coroner's office identified no patients who had been grossly mistriaged, and only insignificant adverse outcomes could be identified. Additional follow-up on 3,740 individuals triaged away was performed by telephone. Responses from this survey indicated that 42% of persons received care elsewhere the same day, 37% within 2 days, and 22% decided not to seek medical care. A group of 1.6% sought care at other hospital EDs for minor complaints. The authors concluded that a group of patients can be selectively triaged out of the ED without significant adverse outcomes, which may offer one approach to the problem of ED overcrowding.

Psychosocial problems during child health supervision visits: eliciting, then what?

Abstract: An explicit goal of child health supervision visits is to gather information and provide guidance about the psychosocial problems of children and families. The purpose of this study was to determine the extent to which parents had opportunities to express psychosocial concerns and the nature of physicians9 responses to these concerns during health supervision visits. The authors analyzed videotapes of child health supervision visits by 34 children aged 5-12 years to 34 pediatric and family medicine residents. Coding systems with acceptable interobserver reliability were developed to assess (1) the nature of opportunities provided to express concerns, (2) categories of psychosocial problems expressed by parents and children, and (3) the nature of physicians9 responses. In 88% of the child health supervision visits, opportunities were created by the physician to discuss psychosocial concerns or were spontaneously raised by the parent or child. In half of the visits, parents or children expressed a total of 30 psychosocial concerns. Psychosocial problems raised included conduct/behavior problems (47%), insecurity (13%), family, sibling, or social problems (13%), learning difficulties (10%), somatization (7%), and other (10%). Physicians9 responses to these psychosocial concerns were as follows: 17% ignored the concern; 43% asked further exploratory questions but provided no information, reassurance, or guidance; 3% reassured the parent; 27% responded with psychosocial information and/or action; 3% responded with medical information and/or action; and 7% responded with a combination of these latter two modes of actions. Pediatric residents were more likely to respond to more disruptive behavioral concerns (r = .60, P < .05). This study has documented that parents and children are given and take the opportunity to express psychosocial concerns to their physicians. Unfortunately, in only 40% of cases did physicians respond with information, reassurance, guidance, or referral. This study suggests the importance of further efforts focusing on the ability of physicians to respond effectively to patients9 psychosocial concerns.

The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service

Abstract: Objectives:1) to determine the rate of alcoholism among general internal medicine inpatients, 2) to assess the recognition and referral rates of these patients by their physicians, 3) to determine the effect of patient gender on physician recognition of alcoholism, and 4) to compare the observed alcoholism rates with rates reported in frequently cited studies, controlling for gender distribution.

Barriers to Pediatric Referral in Managed Care Systems

Abstract: Anecdotal evidence suggests that children9s access to pediatric subspecialty and inpatient care is hampered by referral barriers imposed by managed care systems. To identify such barriers and determine how they affect the referral process, a sample of American Academy of Pediatrics Fellows (n = 1598) was surveyed. The response rate was 79.1% (n = 1264). Of those pediatricians in direct patient care (n = 956), 71.4% participated in a managed care plan. Pediatricians referred patients in managed care systems somewhat less frequently than in traditional pay systems: 8.7% and 6.9% referred managed care patients to subspecialists and inpatient care, respectively, less often. More than 20% and 10% of pediatricians with patients in managed care systems had at least one referral to subspecialist care and inpatient care, respectively, denied in the previous year. Pediatricians experienced more barriers in preferred provider organizations than in health maintenance organizations. These data suggest that utilization management programs, such as those used in managed care systems, may limit necessary access to pediatric subspecialty and inpatient care.

The National Birth Center Study. Part I--Methodology and prenatal care and referrals.

Abstract: This is the first of three articles that will report on the complete findings from the National Birth Center Study (NBCS). This article describes the study methodology, compares the entire group of NBCS subjects with all women who gave birth in the United States in 1986, describes the prenatal care and prenatal referral practices of birth centers in the study, and describes the women who were admitted to the birth centers for intrapartum care with regard to characteristics known or thought to be associated with perinatal risk. Nearly 18,000 women were included in the study; two-thirds of them (n = 11,814) were admitted to the birth centers for intrapartum care. Although medical and obstetric complications were the most common reason for discontinuing birth center care, they accounted for less than half of the women who were not admitted to the birth centers for labor and delivery; many women left for a variety of other reasons. In addition to describing birth center clients, birth center care providers, and birth center care, the NBCS provides detailed information about the characteristics and experiences during pregnancy of a large population of essentially low-risk women receiving a low-intervention style of maternity care.

Screening for Psychosocial Dysfunction In Pediatric Practice A Naturalistic Study of the Pediatric Symptom Checklist

Abstract: This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P<.01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricia...

Compliance with emergency department patient referral.

Abstract: This study evaluated the nature and efficacy of compliance with emergency department (ED) patient referral recommendations. This was a prospective, nonrandomized, descriptive analysis of all ED patients referred mandatorily to an established urban hospital follow-up network. Compliance was measured by analysis of hospital records determined as appointment completion. Patient demographics, urgency of complaint, hospital relationship (new versus established), diagnosis (International Classification of Diseases-9CM), specialty, and method of payment, defined as clinic or private referral, were determined. Comparisons between groups used Fisher's exact test and χ 2 analysis (α = 0.05). There were 2,185 patients encountered with 1,443 (66%) discharged for referral, and an overall compliance rate of 27.8% (401 patients). Patients had a mean age of 36.9 years; 50.6% were male, 94.4% were established patients, 51.1% were clinic cases, and 96.7% had nonurgent complaints. Patients encountered had higher rates of compliance if female (33.9%), greater than 40 years of age (43.4%), with urgent complaints (46.8%), and if referred to private physicians (37.0%) ( P P

Effectiveness of a Pregnancy Smoking Cessation Program

Abstract: Objective To evaluate two nursing approaches to promoting smoking cessation during initial antenatal visits. Design Experimental, with assignment to interventions using a random, alternate‐day strategy and blind assessment of smoking at baseline, 1 month postintervention, 36 weeks' gestation, and 6 weeks postpartum. Setting/Participants: 224 daily smokers, fewer than 31 weeks' gestation, during first prenatal visit, at a teaching hospital antenatal clinic. Interventions: An evening class providing guidance on a self‐help program for 2 hours on a group basis or 20 minutes on an individual basis during the prenatal appointment. Main outcome measure: Smoking cessation, confirmed by urinary cotinine levels. Results: All women assigned to the referral intervention received a referral, but none attended the classes. In contrast, 93% assigned to the immediate intervention received the intervention. The group receiving immediate intervention had two to three times higher rates of cessation at all follow‐up periods, with significant differences at the 1‐month follow‐up. There were certain similarities between the groups. Conclusion: Cessation interventions should be administered during the first prenatal visit.