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Drewry MB, Yanguela J, Khanna A, O'Brien S, Phillips E, Bevel MS, McKinley MW, Corbie G, Dave G. A Systematic Review of Electronic Community Resource Referral Systems. Am J Prev Med 2023; 65:1142-1152. [PMID: 37286015 PMCID: PMC10696135 DOI: 10.1016/j.amepre.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Community Resource Referral Systems delivered electronically through healthcare information technology systems (e.g., electronic medical records) have become more common in efforts to address patients' unmet health-related social needs. Community Resource Referral System connects patients with social supports such as food assistance, utility support, transportation, and housing. This systematic review identifies barriers and facilitators that influence the Community Resource Referral System's implementation in the U.S. by identifying and synthesizing peer-reviewed literature over a 15-year period. METHODS This systematic review was conducted following PRISMA guidelines. A search was conducted on five scientific databases to capture the literature published between January 2005 and December 2020. Data analysis was conducted from August 2021 to July 2022. RESULTS This review includes 41 articles of the 2,473 initial search results. Included literature revealed that Community Resource Referral Systems functioned to address a variety of health-related social needs and were delivered in different ways. Integrating the Community Resource Referral Systems into clinic workflows, maintenance of community-based organization inventories, and strong partnerships between clinics and community-based organizations facilitated implementation. The sensitivity of health-related social needs, technical challenges, and associated costs presented as barriers. Overall, electronic medical records-integration and automation of the referral process was reported as advantageous for the stakeholders. DISCUSSION This review provides information and guidance for healthcare administrators, clinicians, and researchers designing or implementing electronic Community Resource Referral Systems in the U.S. Future studies would benefit from stronger implementation science methodological approaches. Sustainable funding mechanisms for community-based organizations, clear stipulations regarding how healthcare funds can be spent on health-related social needs, and innovative governance structures that facilitate collaboration between clinics and community-based organizations are needed to promote the growth and sustainability of Community Resource Referral Systems in the U.S.
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Affiliation(s)
- Maura B Drewry
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina.
| | - Juan Yanguela
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Anisha Khanna
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Sara O'Brien
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Ethan Phillips
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Malcolm S Bevel
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina; Augusta University, Department of Medicine, Augusta, Georgia
| | - Mary W McKinley
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Giselle Corbie
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Gaurav Dave
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
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Shorey Fennell B, Cottrell-Daniels C, Hoover DS, Spears CA, Nguyen N, Piñeiro B, McNeill LH, Wetter DW, Vidrine DJ, Vidrine JI. The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework. Transl Behav Med 2023; 13:551-560. [PMID: 37000697 PMCID: PMC10415728 DOI: 10.1093/tbm/ibad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.
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Affiliation(s)
| | | | | | - Claire A Spears
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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Hirko KA, Moore P, An LC, Hawley ST. Tobacco Cessation Motivations, Preferences, and Barriers Among Rural Smokers: Implications for Optimizing Referrals in Clinical Practice. AJPM FOCUS 2023; 2:100057. [PMID: 37789934 PMCID: PMC10546510 DOI: 10.1016/j.focus.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Rural‒urban smoking disparities have widened in recent years because smoking prevalence reductions have been experienced disproportionately among urban adults. Tobacco cessation programs that work in urban settings may not be reaching rural smokers or may need tailoring to be effective. Identifying smoking cessation preferences and barriers among rural smokers can facilitate the implementation of acceptable programs to address rural smoking-related disparities. Thus, the aim of this study was to examine tobacco cessation motivations, preferences, and barriers among rural smokers and to assess smokers' likelihood to use various types of tobacco cessation programs. Methods Using a cross-sectional study design, we distributed a self-administered survey to 100 smokers during regularly scheduled healthcare appointments at 3 rural Michigan practices from June to August 2019. We examined differences in participant characteristics by the readiness to quit using chi-square/Fisher's exact tests and described cessation motivations, preferences, and barriers to tobacco cessation among rural smokers. Results Participants reporting readiness to quit were less likely to have smoking allowed in their home (31.7% vs. 75.0%; p=0.003) and had a higher prevalence of anxiety (62.1% vs. 6.3%; p=0.0001) and depression (49.2% vs. 18.8%; p=0.04) than those not ready to quit. Preferences were higher for nicotine replacement medications and reward-based approaches, with only 10% of participants being likely to use telephone-based quitlines. Conclusions These findings suggest that provider referrals to nicotine replacement medications and reward-based approaches can be used to enhance tobacco cessation among rural smokers.
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Affiliation(s)
- Kelly A. Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Patti Moore
- Munson Medical Center, Munson Healthcare, Traverse City, Michigan
| | - Lawrence C. An
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Division of General Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Center for Health Communications Research, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Division of General Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
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McCarthy DE, Baker TB, Zehner ME, Adsit RT, Kim N, Zwaga D, Coates K, Wallenkamp H, Nolan M, Steiner M, Skora A, Kastman C, Fiore MC. A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design. Prev Med 2022; 165:107101. [PMID: 35636564 PMCID: PMC9990874 DOI: 10.1016/j.ypmed.2022.107101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Effective treatments for smoking cessation exist but are underused. Proactive chronic care approaches may enhance the reach of cessation treatment and reduce the prevalence of smoking in healthcare systems. This pragmatic study evaluated a population-based Comprehensive Tobacco Intervention Program (CTIP) implemented in all (6) adult primary care clinics in a Madison, Wisconsin, USA healthcare cooperative, assessing treatment reach, reach equity, and effectiveness in promoting smoking cessation. CTIP launched in 3 waves of 2 clinics each in a multiple baseline design. Electronic health record (EHR) tools facilitated clinician-delivered pharmacotherapy and counseling; guiding tobacco care managers in phone outreach to all patients who smoke; and prompting multimethod bulk outreach to all patients on a smoking registry using an opt-out approach. EHR data were analyzed to assess CTIP reach and effectiveness among 6894 adult patients between January 2018 and February 2020. Cessation treatment reach increased significantly after CTIP launch in 5 of 6 clinics and was significantly higher when clinics were active vs. inactive in CTIP [Odds Ratio (OR) range = 2.0-3.0]. Rates of converting from current to former smoking status were also higher in active vs. inactive clinics (OR range = 2.2-10.5). Telephone treatment reach was particularly high in historically underserved groups, including African-American, Hispanic, and Medicaid-eligible patients. Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access.
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Affiliation(s)
- Danielle E McCarthy
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA.
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Nayoung Kim
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Katherine Coates
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Hannah Wallenkamp
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Margaret Nolan
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Margaret Steiner
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
| | - Christian Kastman
- Group Health Cooperative of South Central Wisconsin, 1265 John Q. Hammons Dr., Madison 53717, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1930 Monroe St., Suite 200, Madison 53711, WI, USA
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Abstract
Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.
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Schaer DA, Singh B, Steinberg MB, Delnevo CD. Tobacco Treatment Guideline Use and Predictors Among U.S. Physicians by Specialty. Am J Prev Med 2021; 61:882-889. [PMID: 34364726 PMCID: PMC8608714 DOI: 10.1016/j.amepre.2021.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Physicians play a critical role in tobacco treatment, being a frequent link to smokers and a trusted source of information. Unfortunately, barriers exist that limit physicians' implementation of evidence-based interventions. This study examines the implementation and predictors of the Ask, Advise, Assess, Assist, Arrange model of tobacco treatment clinical guidelines among U.S. physicians. METHODS A national sample of 1,058 U.S. physicians from 6 specialties (family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonology, and oncology) were surveyed in 2018 (51.8% response rate). Survey domains included demographics, awareness of the guidelines, tobacco treatment practices (i.e., Ask, Advise, Assess, Assist, Arrange model), perceived barriers to treatment, and perceived efficacy of various treatments. Multiple logistic regression analyzed the predictors of implementing guideline activities. RESULTS Mean age was 51.3 years, with the majority male (64.4%) and non-Hispanic White (63.9%). Nearly all physicians reported asking patients whether they smoke (95.6%) and advising them to stop (94.8%), slightly fewer assessed the readiness to quit (86.5%), and only a minority assisted with a quit plan (27.4%) or arranged a follow-up (18.6%). Only 18% reported using the U.S. Public Health Service Guidelines in clinical practice. Time-related factors were the most common barriers (53.4%), with patient factors (36.9%) and financial/resource factors (35.1%) cited less frequently. The predictors of implementing aspects of the Ask, Advise, Assess, Assist, Arrange model included physician awareness and utilization of the U.S. Public Health Service Guidelines, specialty, and to a smaller degree, graduating before 1990, not reporting time as a barrier, patient barriers, sex, and higher perceived effectiveness of pharmacotherapy. CONCLUSIONS This national survey highlights the need for increased implementation of all aspects of the latest guidelines for evidence-based tobacco treatments, including community-based resources.
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Affiliation(s)
- Daniel A Schaer
- The Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michael B Steinberg
- The Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey.
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
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Scheffers-van Schayck T, Hipple Walters B, Otten R, Kleinjan M. Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study. BMC Health Serv Res 2021; 21:973. [PMID: 34530809 PMCID: PMC8444610 DOI: 10.1186/s12913-021-06969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands. .,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands.
| | - Bethany Hipple Walters
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Roy Otten
- Clinical Developmental Psychology, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands
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Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc 2021; 26:778-786. [PMID: 31089727 DOI: 10.1093/jamia/ocz044] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. MATERIALS AND METHODS Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). RESULTS Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). DISCUSSION Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. CONCLUSIONS eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.
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Affiliation(s)
- Michael Fiore
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rob Adsit
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mark Zehner
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Danielle McCarthy
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Susan Lundsten
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Paul Hartlaub
- Family and Preventive Medicine, Brown Deer, Quality and Safety, Primary Care, Ascension Medical Group, Brown Deer, Wisconsin, USA
| | - Todd Mahr
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Allison Gorrilla
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Baker
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Rigotti NA, Schnitzer K, Davis EM, Regan S, Chang Y, Kelley JHK, Notier AE, Gilliam K, Douaihy A, Levy DE, Singer DE, Tindle HA. Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial. Trials 2020; 21:336. [PMID: 32299470 PMCID: PMC7164139 DOI: 10.1186/s13063-020-04257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tobacco smoking remains the leading preventable cause of death in the US. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers. METHODS/DESIGN Helping HAND 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and those who plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant's choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state's telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral. DISCUSSION Helping HAND 4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the US. TRIAL REGISTRATION Prospectively registered prior to start of enrollment at Clinicaltrials.gov, NCT03603496 (July 27, 2018). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00084MJ&selectaction=Edit&uid=U00002G7&ts=2&cx=ff0oxn.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Kristina Schnitzer
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Esa M. Davis
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jennifer H. K. Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
| | - Anna E. Notier
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, TN USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Daniel E. Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Hilary A. Tindle
- Vanderbilt University Medical Center, Nashville, TN USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN USA
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Effects of post-discharge counseling and medication utilization on short and long-term smoking cessation among hospitalized patients. Prev Med Rep 2019; 15:100937. [PMID: 31338281 PMCID: PMC6630019 DOI: 10.1016/j.pmedr.2019.100937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/24/2022] Open
Abstract
Numerous studies have tested the effect of multicomponent post-discharge smoking cessation interventions on post-discharge smoking cessation, and many are effective. However, little is known regarding the relative efficacy of the different intervention components on short or long-term cessation. The present study is a secondary analysis (n = 984) of a randomized controlled trial for hospitalized smokers that took place at two large hospitals in Kansas from 2011 to 2014. All study participants were offered post-discharge quitline services. Pharmacotherapy was recommended during bedside tobacco treatment. The study outcomes were self-reported cessation at 1-month and biochemically verified cessation at 6-months post-randomization. During the post-discharge period, 69% of participants completed at least one quitline call and 28% of participants reported using cessation pharmacotherapy. After controlling for known predictors of cessation among hospitalized smokers, both the number of total quitline calls completed post-discharge and use of cessation pharmacotherapy post-discharge were predictive of cessation at 1-month. After accounting for predictors of cessation and quitting at 1-month, total post-discharge quitline calls was associated with cessation at 6-months (OR [95% CI] = 1.23 [1.12, 1.35], p < 0.001) while post-discharge cessation pharmacotherapy use was not. The results suggest that both engagement in quitline services and use pharmacotherapy independently facilitate cessation beyond the influence of known clinical characteristics associated with cessation. Over the longer term, the effect of engaging in quitline services persists while the effect of pharmacotherapy diminishes. To optimize outcomes, future research should investigate methods to increase utilization of medications and promote sustained counseling engagement in order to sustain the effects of treatment during the post-discharge period. Counseling and pharmacotherapy are effective interventions for helping hospitalized smokers quit smoking, but the relative contribution of each intervention component to short or long-term abstinence is not well understood This secondary analysis of a large clinical trial found that quitline counseling and pharmacotherapy – when used after hospital discharge - were associated with increased odds of quitting smoking at 1-month follow up Controlling for early abstinence at 1 month, only post-discharge quitline counseling remained predictive of cessation at 6-months follow-up Pharmacotherapy and quitline counseling independently facilitate short-term abstinence, while long-term abstinence is facilitated by engagement in quitline counseling services Hospitals could work directly with state quitlines to integrate counseling into post-discharge care
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Warlick C, Richter KP, Mussulman LM, Nazir N, Patel V. Prevalence and predictors of quitline enrollment following hospital referral in real-world clinical practice. J Subst Abuse Treat 2019; 101:25-28. [DOI: 10.1016/j.jsat.2019.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
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Nair US, Reikowsky RC, Allen AM, Bell ML. Quitline program utilization and cessation outcomes: A comparison of provider-referred clients by healthcare settings. Prev Med Rep 2019; 14:100863. [PMID: 31011517 PMCID: PMC6462770 DOI: 10.1016/j.pmedr.2019.100863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
US Public Health Service guidelines recommend that healthcare providers assess patients for tobacco use and refer tobacco users to cessation services (e.g., quitlines). However, once referred, little is known on how program outcomes for referred tobacco users vary across healthcare settings. To examine differences in program enrollment, dropout at follow-up, utilization (number of coaching sessions and nicotine replacement therapy use), and quit outcomes among tobacco users referred across settings to a state quitline. In a retrospective analysis of clients referred to the quitline (January 2011-June 2016), referrals were categorized into six settings: general medical practice (reference group), acute care hospitals, behavioral health, federally qualified health centers (FQHCs), county health departments, and specialty clinics. Outcome variables included enrollment, dropout, program utilization, and 30-day tobacco abstinence at 7-month follow-up. Compared to medical practices, clients referred from behavioral health were less likely to enroll in services (OR = 0.81, 95%CI: 0.76, 0.87), less likely to report using NRT in-program (OR = 0.51, 95%CI: 0.42, 0.62), and along with clients referred from FQHCs (OR = 0.78, 95%CI: 0.64, 0.94) were less likely to be quit at follow-up (OR = 0.73, 95%CI: 0.59, 0.92). Clients referred from acute care hospitals were less likely to enroll in services (OR = 0.60, 95%CI: 0.56, 0.64) and were more likely to drop-out of cessation services (OR = 1.12; 95%CI: 1.00-1.26). Findings reflect the need for better tailoring of messages for tobacco assessment within specific healthcare settings while bolstering behavioral counseling that quitlines provide to increase enrollment, engagement, and retention in tobacco cessation services.
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Affiliation(s)
- Uma S. Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
- Corresponding author.
| | - Ryan C. Reikowsky
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
| | - Alicia M. Allen
- Family & Community Medicine Department, College of Medicine, University of Arizona, 3950 South Country Club Drive, Suite 330, Tucson, AZ 85714, United States of America
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
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Engle JL, Mermelstein R, Baker TB, Smith SS, Schlam TR, Piper ME, Jorenby DE, Collins LM, Cook JW. Effects of motivation phase intervention components on quit attempts in smokers unwilling to quit: A factorial experiment. Drug Alcohol Depend 2019; 197:149-157. [PMID: 30825795 PMCID: PMC6573018 DOI: 10.1016/j.drugalcdep.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. METHODS This study is a secondary analysis of a 4-factor randomized factorial experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. RESULTS Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p < .05). Conversely, nicotine patch reduced quit attempts when used with BR. Patch also discouraged use of cessation treatment (15.8% vs. 23% without patch; p < .05). Aided vs. unaided quit attempts produced abstinence in 42% vs. 10% of participants, respectively. CONCLUSION Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.
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Affiliation(s)
- Jessica L. Engle
- William S. Middleton Memorial Veterans Hospital, Addictive Disorders Treatment Program, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago (MC 275), 544 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Tanya R. Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Megan E. Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Linda M. Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development & Family Studies, 404 Health and Human Development Building, University Park, PA 16802
| | - Jessica W. Cook
- William S. Middleton Memorial Veterans Hospital, Addictive Disorders Treatment Program, 2500 Overlook Terrace, Madison, WI, 53705, USA.,Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
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Predictors of engagement in post-discharge quitline counseling among hospitalized smokers. J Behav Med 2018; 42:139-149. [PMID: 30027388 DOI: 10.1007/s10865-018-9951-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/13/2018] [Indexed: 01/02/2023]
Abstract
Quitlines provide evidence-based tobacco treatment and multiple calls yield higher quit rates. This study aimed to identify subgroups of smokers with greater quitline engagement following referral during hospitalization. Data were from a randomized clinical trial assessing the effectiveness of fax referral (referral faxed to proactive quitline) versus warm handoff (patient connected to quitline at bedside) (n = 1054). Classification and regression trees analyses evaluated individual and treatment/health system-related variables and their interactions. Among all participants, warm handoff, higher ratings of the tobacco treatment care transition, and being older predicted completing more quitline calls. Among patients enrolled in the quitline, higher transition of care ratings, being older, and use of cessation medication post-discharge predicted completing more calls. Three of the four factors influencing engagement were characteristics of treatment within the hospital (quality of tobacco treatment care transition and referral method) and therapy (use of cessation medications), suggesting potential targets to increase quitline engagement post-discharge.
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Mussulman LM, Faseru B, Fitzgerald S, Nazir N, Patel V, Richter KP. A randomized, controlled pilot study of warm handoff versus fax referral for hospital-initiated smoking cessation among people living with HIV/AIDS. Addict Behav 2018; 78:205-208. [PMID: 29216569 DOI: 10.1016/j.addbeh.2017.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/24/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The prevalence of smoking among people living with HIV/AIDS (PLWHA) remains higher than the general population. Life expectancy among PLWHA has increased over the past decade, however, PLWHA who smoke will die younger than their non-smoking peers. The primary aim of this pilot study was to examine the effects of warm handoff versus fax referral to the quitline for smoking cessation among hospitalized smokers living with HIV/AIDS. METHODS 25 smokers with a diagnosis of HIV/AIDS hospitalized at a Midwestern academic medical center in 2012-2013 (19 male; mean age=47.7; 48% African-American) were identified, approached, and randomized to one of two treatment arms. At the bedside for patients in warm handoff, staff telephoned the quitline for on-the-spot enrollment and counseling. Participants randomized to fax were fax-referred to the quitline on the day of discharge. The quitline provided continued outpatient counseling to participants in both conditions. The main outcome was verified tobacco abstinence at 6-months post randomization. RESULTS Enrollment and participation in quitline counseling was high among both warm handoff (100%) and fax-referred (71.4%) PLWHA participants. Nearly all completed follow up for outcome data collection at 6months. Verified abstinent rates were 45.5% in warm handoff versus 14.3% in fax referral at 6months (not significant). CONCLUSIONS Hospitalized smokers living with HIV/AIDS were highly engaged in quitline services. Warm handoff seems a promising intervention for hospitalized PLWHA that requires further exploration. Clinical Trials Registration NCT01305928.
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Affiliation(s)
- Laura M Mussulman
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
| | - Babalola Faseru
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
| | - Sharon Fitzgerald
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
| | - Niaman Nazir
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
| | - Vivek Patel
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
| | - Kimber P Richter
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States.
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Nair US, Reikowsky RC, Wertheim BC, Thomson CA, Gordon JS. Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline. Am J Health Promot 2018; 32:1510-1517. [PMID: 29325439 DOI: 10.1177/0890117117749366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate how mode of entry into a quitline influences program utilization and quit outcomes among clients seeking cessation services. DESIGN This is a retrospective analysis of clients receiving quitline services from January 2011 to June 2016. SETTING The study was conducted at the Arizona Smokers' Helpline. PARTICIPANTS Enrolled clients completed a 7-month follow-up (N = 18 650). MEASURES The independent variable was referral mode of entry (ie, proactive, passive, and self-referral). Outcome variables included tobacco cessation medication use, number of coaching sessions completed, and 30-day tobacco abstinence at 7 months. ANALYSIS Logistic regression was used to analyze tobacco abstinence after controlling for potential confounders. RESULTS Compared to self-referred clients, proactively referred clients were least likely (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.97), whereas passively referred clients were most likely (OR: 1.14; 95% CI: 1.00-1.30) to report tobacco abstinence. Proactively referred (OR: 0.79; 95% CI: 0.70-0.88), but not passively referred, clients were 21% less likely to report tobacco cessation medication use than self-referred clients. CONCLUSION Proactive referrals are associated with lower utilization of tobacco cessation medication and less successful quit outcomes; however, provider referrals are critical to reaching tobacco users who may have more significant health risks and barriers to quitting. Examining potential barriers among both providers and provider-referred clients is needed to inform improvements in training providers on brief interventions for tobacco cessation.
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Affiliation(s)
- Uma S Nair
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ryan C Reikowsky
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Cynthia A Thomson
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Judith S Gordon
- 3 College of Nursing, University of Arizona, Tucson, AZ, USA
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Thomas KEH, Kisely S, Urrego F. Electronic Heath Record Prompts May Increase Screening for Secondhand Smoke Exposure. Clin Pediatr (Phila) 2018; 57:27-30. [PMID: 28135880 DOI: 10.1177/0009922816688261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics recommends that pediatricians promote smoking cessation among caregivers at every visit. Currently, there are inconsistencies between recommendations and clinical practice. This study aims to compare results generated from 3 intervention methods on the rate at which pediatricians screen for secondhand smoke exposure (SHSe). METHODS Pediatricians were randomly assigned to 1 of 3 intervention groups: no lecture, changes in electronic health record (EHR) (G1); lecture, no changes in the EHR (G2); or a lecture and EHR changes (G3). Data between groups were compared using a 1-way analysis of variance. RESULTS Documentation of SHSe was statistically significantly greater in G3, when compared with G1 and G2 ( P < .01). Documentation of SHSe was statistically significantly greater in G1, when compared with G2 ( P < .05). CONCLUSION A brief lecture with EHR prompts may be a simple way to increase screening for SHSe in the pediatric primary care setting.
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Affiliation(s)
| | - Steve Kisely
- 2 University of Queensland, Brisbane, Queensland, Australia
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18
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Wang MP, Suen YN, Li WHC, Lam COB, Wu SYD, Kwong ACS, Lai VW, Chan SS, Lam TH. Intervention With Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial. JAMA Intern Med 2017; 177:1790-1797. [PMID: 29059277 PMCID: PMC5820734 DOI: 10.1001/jamainternmed.2017.5793] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most smoking cessation (SC) clinics are costly, passive, and underused. OBJECTIVE To compare the SC effect of a combined intervention involving brief, model-guided SC advice plus active referral to SC services (active referral group) with those of brief, model-guided SC advice only (brief advice group) and general SC advice only (control group). DESIGN, SETTING, AND PARTICIPANTS A single-blind, 3-arm, pragmatic cluster randomized clinical trial was conducted including 1226 adult daily smokers in the general Hong Kong community proactively recruited to participate in the Quit-to-Win Contest held in 2015. The study was conducted from June 20 to September 24, 2015. Participants were randomly allocated to the active referral (n = 402), brief advice (n = 416), and control (n = 408) groups. Intention-to-treat analysis was used. INTERVENTIONS Brief telephone counseling was offered to the active referral and brief advice groups at 1 and 2 months. Interventions were delivered by SC ambassadors who had undergone a short training period. MAIN OUTCOMES AND MEASURES The primary outcome was the self-reported past 7-day point prevalence of abstinence (PPA) at 6 months. The secondary outcomes were carbon monoxide level-validated abstinence, smoking reduction, and SC service use. RESULTS Participants included 991 (80.8%) men; mean (SD) age was 42.0 (14.8) years. The response rate was 68.2% at 3 and 72.3% at 6 months. The corresponding PPAs were 18.9% and 17.2% in the active referral group-higher than in the brief advice (8.9% and 9.4%; both P ≤ .001) or control (14.0% and 11.5%; P = .03 at 6 months) groups. Compared with the other 2 groups, the active referral group had significantly higher validated abstinence rates (10.2% at 3 months and 9.0% at 6 months, all P < .05) with odds ratios of 2.84 (95% CI, 1.57-5.15) and 2.61 (95% CI, 1.46-4.68) at 3 months, and 1.85 (95% CI, 1.06-3.23) and 1.81 (95% CI, 1.04-3.16) at 6 months in the brief advice and control groups, respectively. The SC service use rate was significantly higher in the active referral group (25.1%) than in either brief advice (2.4%) or control (3.4%) groups at 6 months (P < .001). CONCLUSIONS AND RELEVANCE An intervention involving brief advice and active referral delivered to smokers in the community by volunteers can increase quitting in places where SC services are available but underused. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02539875.
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Affiliation(s)
- Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | | | | | | | - Vienna W Lai
- Hong Kong Council on Smoking and Health, Hong Kong
| | - Sophia S Chan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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A Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention. Anesth Analg 2017; 125:571-579. [DOI: 10.1213/ane.0000000000001894] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Asfar T, Lee DJ, Lam BL, Murchison AP, Mayro EL, Owsley C, McGwin G, Gower EW, Friedman DS, Saaddine J. Evaluation of a Web-Based Training in Smoking Cessation Counseling Targeting U.S. Eye-Care Professionals. HEALTH EDUCATION & BEHAVIOR 2017; 45:181-189. [DOI: 10.1177/1090198117709883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Smoking causes blindness-related diseases. Eye-care providers are uniquely positioned to help their patients quit smoking. Aims. Using a pre-/postevaluation design, this study evaluated a web-based training in smoking cessation counseling targeting eye-care providers. Method. The training was developed based on the 3A1R protocol: “Ask about smoking, Advise to quit, Assess willingness to quit, and Refer to tobacco quitlines,” and made available in the form of a web-based video presentation. Providers ( n = 654) at four academic centers were invited to participate. Participants completed pretraining, posttraining, and 3-month follow-up surveys. Main outcomes were self-reported improvement in their motivation, confidence, and counseling practices at 3-month follow-up. Generalized linear mixed models for two time-points (pretraining and 3-month) were conducted for these outcomes. Results. A total of 113 providers (54.0% males) participated in the study (17.7% response rate). At the 3-month evaluation, 9.8% of participants reported improvement in their motivation. With respect to the 3A1R, 8% reported improvement in their confidence for Ask, 15.5% for Advise, 28.6% for Assess, and 37.8% for Refer. Similarly, 25.5% reported improvement in their practices for Ask, 25.5% for Advise, 37.2% for Assess, and 39.4% for Refer to tobacco quitlines ( p < .001 for all except for Refer confidence p = .05). Discussion. Although participation rate was low, the program effectively improved providers’ smoking cessation counseling practices. Conclusions. Including training in smoking cessation counseling in ophthalmology curriculums, and integrating the 3A1R protocol into the electronic medical records systems in eye-care settings, might promote smoking cessation practices in these settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tague C, Richter KP, Cox LS, Keighley J, Hutcheson T, Fitzgerald SA, Ellerbeck EF. Impact of Telephone-Based Care Coordination on Use of Cessation Medications Posthospital Discharge: A Randomized Controlled Trial. Nicotine Tob Res 2017; 19:299-306. [PMID: 27194545 PMCID: PMC7207068 DOI: 10.1093/ntr/ntw138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 05/07/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokers benefit from ongoing cessation support upon leaving the hospital and returning to their home environment. This study examined the impact of telephone-delivered care coordination on utilization of and adherence to cessation pharmacotherapy after hospital discharge. METHODS Inpatient smokers (n = 606) were randomized to receive counseling with care coordination (CCC) or counseling alone (C) for smoking cessation. Both groups received written materials and telephone-based cessation counseling during hospitalization and postdischarge. CCC recipients received help in selecting, obtaining, and refilling affordable pharmacotherapy prescriptions during and after hospitalization. Study outcomes included self-reported utilization, duration of use, and type of medication during the 3 months postdischarge. RESULTS Of the 487 (80%) of participants completing 3-month follow-up, 211 (43.3%) reported using cessation pharmacotherapy postdischarge; this did not differ by study arm (CCC: 44.7%, C: 42.0%, p = .55). Use of pharmacotherapy postdischarge was associated with smoking at least 20 cigarettes/day at baseline (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.00-2.19) and receipt of pharmacotherapy during hospitalization (OR: 4.00; 95% CI: 2.39-6.89). Smokers with Medicaid (OR: 2.29; 95% CI: 1.32-4.02) or other insurance (OR: 1.69; 95% CI: 1.01-2.86) were more likely to use pharmacotherapy postdischarge than those with no health care coverage. Less than one in four (23.8% of CCC; 22.2% of C) continued pharmacotherapy beyond 4 weeks. CONCLUSIONS Supplemental care coordination did not improve use of postdischarge pharmacotherapy beyond that of inpatient treatment and behavioral counseling. Insurance coverage and use of medications during the hospitalization are associated with higher use of evidence-based treatment postdischarge. IMPLICATIONS Many hospitalized smokers do not receive the benefits of cessation pharmacotherapy postdischarge and telephone quitline programs often fail to help smokers procure pharmacotherapy. Thus, effective strategies are needed to improve utilization and adherence to evidence-based cessation therapies when smokers leave the hospital. We found that use of postdischarge pharmacotherapy was strongly associated with receipt of pharmacotherapy during the hospitalization and with the availability of insurance to cover the costs of treatment. Additional efforts to coordinate pharmacotherapy services did not improve either utilization or adherence to therapy.
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Affiliation(s)
- Caleb Tague
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Lisa S Cox
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - John Keighley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Tresza Hutcheson
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Sharon A Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
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Sherman SE, Krebs P, York LS, Cummins SE, Kuschner W, Guvenc-Tuncturk S, Zhu SH. Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models. Tob Control 2017; 27:78-82. [PMID: 28190003 DOI: 10.1136/tobaccocontrol-2016-053327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. METHODS Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers' Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. OUTCOME Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). CONCLUSION Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible. TRIAL REGISTRATION NUMBER NCT00123682.
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Affiliation(s)
- Scott E Sherman
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Paul Krebs
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Laura S York
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Ware Kuschner
- VA Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sebnem Guvenc-Tuncturk
- Department of Pulmonary and Critical Care Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
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24
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Richter KP, Faseru B, Shireman TI, Mussulman LM, Nazir N, Bush T, Scheuermann TS, Preacher KJ, Carlini BH, Magnusson B, Ellerbeck EF, Cramer C, Cook DJ, Martell MJ. Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines. Am J Prev Med 2016; 51:587-96. [PMID: 27647059 PMCID: PMC5031370 DOI: 10.1016/j.amepre.2016.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Few hospitals treat patients' tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge. STUDY DESIGN Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014-June 2015. SETTING/PARTICIPANTS The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish. INTERVENTION Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge. MAIN OUTCOME MEASURES Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness. RESULTS Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001). CONCLUSIONS One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services.
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Affiliation(s)
- Kimber P Richter
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas.
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Laura M Mussulman
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Kristopher J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | | | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Carol Cramer
- Tobacco Use Prevention, Kansas Department of Health and Environment, Topeka, Kansas
| | - David J Cook
- Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas
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25
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Drehmer JE, Hipple B, Nabi-Burza E, Ossip DJ, Chang Y, Rigotti NA, Winickoff JP. Proactive enrollment of parents to tobacco quitlines in pediatric practices is associated with greater quitline use: a cross-sectional study. BMC Public Health 2016; 16:520. [PMID: 27342141 PMCID: PMC4919852 DOI: 10.1186/s12889-016-3147-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every U.S. state has a free telephone quitline that tobacco users can access to receive cessation assistance, yet referral rates for parents in the pediatric setting remain low. This study evaluates, within pediatric offices, the impact of proactive enrollment of parents to quitlines compared to provider suggestion to use the quitline and identifies other factors associated with parental quitline use. METHODS As part of a cluster randomized controlled trial (Clinical Effort Against Secondhand Smoke Exposure), research assistants completed post-visit exit interviews with parents in 20 practices in 16 states. Parents' quitline use was assessed at a 12-month follow-up interview. A multivariable analysis was conducted for quitline use at 12 months using a logistic regression model with generalized estimating equations to account for provider clustering. Self-reported cessation rates were also compared among quitline users based on the type of referral they received at their child's doctor's office. RESULTS Of the 1980 parents enrolled in the study, 1355 (68 %) completed a 12-month telephone interview and of those 139 (10 %) reported talking with a quitline (15 % intervention versus 6 % control; p < .0001). Parents who were Hispanic (aOR 2.12 (1.22, 3.70)), black (aOR 1.57 (1.14, 2.16)), planned to quit smoking in the next 30 days (aOR 2.32 (1.47, 3.64)), and had attended an intervention practice (aOR 2.37 (1.31, 4.29)) were more likely to have talked with a quitline. Parents who only received a suggestion from a healthcare provider to use the quitline (aOR 0.45 (0.23, 0.90)) and those who were not enrolled and did not receive a suggestion (aOR 0.33 (0.17, 0.64)) were less likely to talk with a quitline than those who were enrolled in the quitline during the baseline visit. Self-reported cessation rates among quitline users were similar regardless of being proactively enrolled (19 %), receiving only a suggestion (25 %), or receiving neither a suggestion nor an enrollment (17 %) during a visit (p = 0.47). CONCLUSIONS These results highlight the enhanced clinical effectiveness of not just recommending the quitline to parents but also offering them enrollment in the quitline at the time of their child's visit to the pediatric office. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT00664261.
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Affiliation(s)
- Jeremy E Drehmer
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Bethany Hipple
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan P Winickoff
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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26
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Brief advice and active referral for smoking cessation services among community smokers: a study protocol for randomized controlled trial. BMC Public Health 2016; 16:387. [PMID: 27169630 PMCID: PMC4866301 DOI: 10.1186/s12889-016-3084-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background Most smokers do not use smoking cessation (SC) services although it increases successful quits. Passive referral providing SC information to smokers is commonly used in SC studies. Little was known about active referral in the community setting. This study aims to motivate community smokers to quit by brief SC advice using a validated AWARD model (Ask, Warn, Advise, Refer and Do-it-again) that adjunct with active referral of smokers to various SC services in Hong Kong. Methods/Design This is a single-blinded, parallel three-armed cluster randomized controlled trial (RCT) with two treatment groups of (1) brief SC advice using the AWARD model, active referral to SC services plus a referral card and a health warning leaflet (active referral group) and (2) brief SC advice using AWARD model and health warning leaflet (brief advice group) and a control group receives general very brief advice with a self-help booklet. A total of 1291 smokers will be recruited from 66 clusters (recruitment sessions) with 22 will be allocated to each of the two intervention and one control groups. SC ambassadors will be trained for delivering the interventions and conducting telephone follow-up. The primary outcomes are self-reported 7-days point prevalence (PP) abstinence at 3 and 6 months follow-up. Intention-to-treat principle and multi-level regressions will be used for data analysis. Discussion This is the first RCT on assessing a model combining brief advice and active referral to SC services among community smokers. The results will inform the practices of SC services and intervention studies. Trial registration NCT02539875 (ClinicalTrials.gov registry; registered retrospectively on 22 July 2015)
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27
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Cook JW, Collins LM, Fiore MC, Smith SS, Fraser D, Bolt DM, Baker TB, Piper ME, Schlam TR, Jorenby D, Loh WY, Mermelstein R. Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment. Addiction 2016; 111:117-28. [PMID: 26582140 PMCID: PMC4681585 DOI: 10.1111/add.13161] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
AIMS To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DESIGN A balanced, four-factor, randomized factorial experiment. SETTING Eleven primary care clinics in southern Wisconsin, USA. PARTICIPANTS A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. INTERVENTIONS Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. MEASUREMENTS The primary outcome was percentage change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. FINDINGS There were few main effects, but a significant four-way interaction at 26 weeks post-study enrollment (P = 0.01, β = 0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P = 0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt (P = 0.01). CONCLUSIONS Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.
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Affiliation(s)
- Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Linda M. Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development & Family Studies, 404 Health and Human Development Building, University Park, PA 16802
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - David Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Tanya R. Schlam
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Douglas Jorenby
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, 1220 Medical Sciences Center, 1300 University Ave., Madison, WI 53706
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 544 Westside Research Office Bldg., 1747 West Roosevelt Rd., Chicago, IL 60608
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Houston TK, Sadasivam RS, Allison JJ, Ash AS, Ray MN, English TM, Hogan TP, Ford DE. Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study. Implement Sci 2015; 10:154. [PMID: 26525410 PMCID: PMC4630887 DOI: 10.1186/s13012-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months. Methods Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an “e-referral tool” to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper “referral prescription”). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized). Results Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p < 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04). Conclusions Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation. Trial Registration Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0336-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas K Houston
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA. .,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA. .,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rajani S Sadasivam
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeroan J Allison
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arlene S Ash
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas M English
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy P Hogan
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel E Ford
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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29
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Griffin JL, Segal KS, Nahvi S. Barriers to Telephone Quitline Use Among Methadone-Maintained Smokers. Nicotine Tob Res 2015; 17:931-6. [PMID: 26180217 PMCID: PMC4542843 DOI: 10.1093/ntr/ntu267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/01/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Drug users have high rates of tobacco use and tobacco-related disease. Telephone quitlines promote smoking cessation, but their reach among drug users is unknown. We thus aimed to assess utilization of and barriers to telephone quitlines among methadone-maintained smokers. METHODS Subjects were opioid-dependent smokers in Bronx, New York, methadone treatment programs who were enrolled in a clinical trial of varenicline. All subjects were offered referral to a free, proactive quitline. We examined quitline records, surveyed barriers to quitline use, and queried reasons for declining referral. RESULTS Of the 112 subjects enrolled, 47% were male, 54% were Hispanic, and 28% were Black. All subjects were offered referral, and 25 (22% of study participants) utilized the quitline. Quitline utilizers (vs. nonutilizers) were significantly more likely to have landline phone service (72 vs. 42%, p = .01), interest in quitline participation (92 vs. 62%, p < .01), and willingness to receive calls (96 vs. 76%, p = .02). Nonutilizers were significantly more likely to report cell phone service lapse (38 vs. 14%, p = .04), and difficulty charging cell phones (19 vs. 0%, p = .02). Reasons for quitline refusal included: (a) skepticism of quitline efficacy; (b) aversion to telephone communication; (c) competing life demands (e.g., drug treatment, shelter); and (d) problems with cell phone service or minutes. CONCLUSIONS Despite several limitations to quitline access among methadone-maintained smokers, routine quitline referral was associated with 22% utilization. To expand provision of smoking cessation treatment to opioid-dependent smokers, interventions to promote routine quitline referral in substance abuse treatment programs warrant investigation.
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Affiliation(s)
- Judith L Griffin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Kate S Segal
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY
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30
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Leuthard JL, Beebe LA, Halstead L, Olson KD, Roysdon JW. Increased evidence-based tobacco treatment through Oklahoma hospital system changes. Am J Prev Med 2015; 48:S65-70. [PMID: 25528711 DOI: 10.1016/j.amepre.2014.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Oklahoma hospitals admit approximately 120,000 tobacco users each year, many for diseases resulting from tobacco use. PURPOSE To describe a unique partnership between the Oklahoma Hospital Association and Oklahoma Tobacco Settlement Endowment Trust to reach more tobacco users through the implementation of sustainable health system changes within hospitals and clinics to integrate an evidence-based tobacco treatment protocol for all tobacco-using patients. METHODS The Oklahoma Hospital Association tobacco-cessation model included (1) identifying all tobacco-using patients; (2) assessing addiction level and readiness to quit; (3) prescribing medications to manage withdrawal while in hospital; and (4) proactively faxing a referral to the Oklahoma Tobacco Helpline for all patients ready to quit. Helpline registration patterns and characteristics of fax-referred hospitalized patients were tracked for the 4 years of the initiative (2009-2013); data were analyzed in 2013. RESULTS Twenty-one hospitals and 12 clinics participated in the initiative. Fax referrals to the Helpline increased by >150% in the first year, from about 600 during the year prior to the implementation of the program (July 2009 to June 2010) to 1,581 from Oklahoma Hospital Association facilities alone in the first year following the launch of the initiative. Nearly 5,600 Oklahoma Hospital Association fax referrals were made during the 4-year study period. About 41% of these referrals resulted in Helpline enrollment (n=2,289). CONCLUSIONS Sustainable, evidence-based tobacco treatment interventions embedded in hospital systems can successfully identify tobacco users and provide effective treatment, including increased proactive Helpline referrals for quit coaching.
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Affiliation(s)
- Joy L Leuthard
- Quality & Clinical Initiatives (Leuthard, Halstead, Roysdon), Oklahoma Hospital Association, Oklahoma City, Oklahoma.
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - LaWanna Halstead
- Quality & Clinical Initiatives (Leuthard, Halstead, Roysdon), Oklahoma Hospital Association, Oklahoma City, Oklahoma
| | - Kimbra D Olson
- Community Health & Employee Wellness (Olson), INTEGRIS Health, Oklahoma City, Oklahoma
| | - Jennifer W Roysdon
- Quality & Clinical Initiatives (Leuthard, Halstead, Roysdon), Oklahoma Hospital Association, Oklahoma City, Oklahoma
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Enrolling Smokers from Health Systems into Quitline Services: ‘Results of two enrollment strategies’. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To determine the effects of motivational interviewing (MI) counselling versus a minimal intervention control on the enrollment of smokers in the Minnesota QUITPLAN Helpline.Study design: Two-group randomized controlled trial of 235 community-dwelling adult smokers. Participants were randomly assigned to receive either a three-session phone based motivational interviewing intervention (n = 118) or the control (n = 117) consisting of mailed printed materials about the Minnesota QUITPLAN helpline services.Data collection: Participants completed demographic and smoking-related survey questionnaire at baseline (by mail) and at weeks 4 and 26 (by phone) follow-up. Quitline enrollment status data was provided by the Minnesota QUITPLAN Helpline.Principal findings: At week 4 follow-up, a higher proportion of participants in the MI group (22.3%) had enroled in the Minnesota QUITPLAN Helpline compared to those in the control arm (13.6%; p = 0.098). At week 26 follow-up, enrollment rates were similar for MI (28.0%) and control (26.5%) arms. Of those who enroled in the Helpline, participants in the MI group reported completing more Helpline sessions than those in control group (4.9 vs. 3.2; p = 0.087).There was no significant interaction between readiness to quit and intervention for the outcome of enrollment in the Helpline.Conclusions: A minimal intensity control such as mailing printed materials resulted in quitline enrollment rates similar to a more resource intensive intervention like motivational interviewing and several folds higher than the current state or national averages. We recommend that health plans should consider mailing smoking cessation promotional messages to encourage smokers to enrol in quitlines.
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Sharifi M, Adams WG, Winickoff JP, Guo J, Reid M, Boynton-Jarrett R. Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke. Acad Pediatr 2014; 14:478-84. [PMID: 25169159 DOI: 10.1016/j.acap.2014.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care. METHODS Within a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills. RESULTS The baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre-post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention. CONCLUSIONS Implementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.
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Affiliation(s)
- Mona Sharifi
- Division of General Academic Pediatrics/Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Mass.
| | - William G Adams
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics/Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Mass
| | - Jing Guo
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass
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Vidrine JI, Shete S, Li Y, Cao Y, Alford MH, Galindo-Talton M, Rabius V, Sharp B, Harmonson P, Zbikowski SM, Miles L, Wetter DW. The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med 2013; 45:737-41. [PMID: 24237916 PMCID: PMC4023543 DOI: 10.1016/j.amepre.2013.07.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/17/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment. PURPOSE Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system. DESIGN The study design was a pair-matched group-randomized trial with two treatment arms. SETTING/PARTICIPANTS Ten safety net clinics in Houston TX. INTERVENTION Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. MAIN OUTCOME MEASURES The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment. RESULTS The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06). CONCLUSIONS The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.
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Schauer GL, Malarcher AM, Zhang L, Engstrom MC, Zhu SH. Prevalence and correlates of quitline awareness and utilization in the United States: an update from the 2009-2010 National Adult Tobacco Survey. Nicotine Tob Res 2013; 16:544-53. [PMID: 24253378 DOI: 10.1093/ntr/ntt181] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco quitlines are evidence-based cessation resources that have been underutilized. The purpose of this study is to provide population-level data about quitline awareness and utilization in the United States and to assess correlates of awareness and utilization. METHODS Data were from the 2009-2010 National Adult Tobacco Survey. Descriptive statistics were produced for national- and state-level quitline awareness and for national quitline utilization. Bivariate and multivariable logistic regressions were used to identify correlates of quitline awareness and utilization. RESULTS Quitline awareness among the total sample was 33.9% (current smokers 53.9%, former smokers 34.0%, never-smokers 27.0%). Awareness varied by state (range: 35.8%-84.6% for current smokers). Among current smokers who tried to quit in the past year, correlates of lower awareness included being Black, non-Hispanic, and making <$50,000 annually; correlates of higher awareness included having seen a health professional, higher state tobacco program expenditures, and being female. Among smokers who made at least one quit attempt in the previous year and were aware of the quitline, quitline utilization was 7.8%. Higher state tobacco program expenditure, health professional advice, and being Black, non-Hispanic were correlated with higher utilization; older age was correlated with lower utilization. Awareness was significantly associated with use at the state level (r = .98, p < .01). CONCLUSION Although the majority of smokers in the United States are aware of quitlines, only a small percentage of those trying to quit utilize them. State tobacco program expenditures and receipt of advice from a health professional were associated with both higher quitline awareness and higher utilization.
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Affiliation(s)
- Gillian L Schauer
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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Greenwood DA, Parise CA, MacAller TA, Hankins AI, Harms KR, Pratt LS, Olveda JE, Buss KA. Utilizing clinical support staff and electronic health records to increase tobacco use documentation and referrals to a state quitline. JOURNAL OF VASCULAR NURSING 2013; 30:107-11. [PMID: 23127426 DOI: 10.1016/j.jvn.2012.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine if incorporation of a workflow in the electronic health record (EHR) that empowered medical assistants (MA) to become tobacco-cessation promoters, would increase tobacco documentation and referral for cessation counseling. MAs in three primary care centers were trained to ask every patient, at every visit, about tobacco use then document this status in the EHR. Patients ready to quit were electronically referred to the quitline for tobacco cessation counseling. Documentation of tobacco status, ongoing verification of tobacco use, and chief complaint recording was compared before and after the intervention. Logistic regression analysis indicated that after adjusting for differences between care centers, there were increased odds in initial documentation (OR = 1.52; 95% CI = 1.42 - 1.62) and ongoing verification (OR = 2.86; 95% CI = 1.42 - 1.62) in 2010 in comparison with 2009. Recording of tobacco cessation as the chief complaint in current smokers increased 91% (OR = 1.91; 95% CI = 1.56 - 2.34). Documentation and referrals for smoking cessation can be increased in organizations using EHR by empowering MAs to promote tobacco cessation and providing electronic referral options.
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Piper ME, Baker TB, Mermelstein R, Collins LM, Fraser DL, Jorenby DE, Smith SS, Christiansen BA, Schlam TR, Cook JW, Oguss M, Fiore MC. Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record. Transl Behav Med 2013; 3:253-63. [PMID: 24073176 DOI: 10.1007/s13142-012-0178-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care systems using electronic health records (EHRs). The EHR prompted primary care clinic staff to invite patients who smoked to participate in a tobacco treatment program. Patients who accepted and were eligible were offered smoking reduction or cessation treatment. More than 65 % of smokers were invited to participate, and 12.4 % of all smokers enrolled in treatment-30 % in smoking reduction and 70 % in cessation treatment. The chronic care model developed for treating tobacco dependence, integrated into the primary care system through the EHR, has the potential to engage up to 4.3 million smokers in treatment a year.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, WI 53711 USA
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Kirst M, Schwartz R. Promoting a smokers' quitline in Ontario, Canada: an evaluation of an academic detailing approach. Health Promot Int 2013; 30:310-7. [PMID: 23766445 DOI: 10.1093/heapro/dat040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study assesses the impact of an academic detailing quitline promotional outreach program on integration of patient referrals to the quitline by fax in healthcare settings and quitline utilization in Ontario, Canada. The study employed a mixed methods approach for evaluation, with trend analysis of quitline administrative data from the year before program inception (2005) to 2011 and qualitative interviews with quitline stakeholders. Participants in the qualitative interviews included academic detailing program staff, regional tobacco control stakeholders and quitline promotion experts. Quantitative outcomes included the number of fax referral partners and fax referrals received, and quitline reach. Trends in proximal and distal outreach program outcomes were assessed. The qualitative data were analysed through a process of data coding involving the constant comparative technique derived from grounded theory methods. The study identified that the outreach program has had some success in integrating the fax referral program in healthcare settings through evidence of increased fax referrals since program inception. However, organizational barriers to program partner engagement have been encountered. While referral from health professionals through the fax referral programs has increased since the inception of the outreach program, the overall reach of the quitline has not increased. The study findings highlight that an academic detailing approach to quitline promotion can have some success in achieving increased fax referral program integration in healthcare settings. However, findings suggest that investment in a comprehensive promotional strategy, incorporating academic detailing, media and the provision of free cessation medications may be a more effective approach to quitline promotion.
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Affiliation(s)
- Maritt Kirst
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada M5T 3M7
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada M5T 3M7
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Vidrine JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, Miles L, Zbikowski SM, Wetter DW. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA Intern Med 2013; 173:458-64. [PMID: 23440173 PMCID: PMC3858085 DOI: 10.1001/jamainternmed.2013.3751] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance. OBJECTIVE To evaluate a new approach--Ask-Advise-Connect (AAC)--designed to address barriers to linking smokers with treatment. DESIGN A pair-matched, 2-treatment-arm, group-randomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011. SETTING Ten clinics in Houston, Texas. PARTICIPANTS Smoking status assessments were completed for 42,277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics. INTERVENTIONS Linking smokers with quitline-delivered treatment. MAIN OUTCOME MEASURE Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment. RESULTS In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t4 = 9.19 [P < .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. CONCLUSIONS AND RELEVANCE The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.
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Affiliation(s)
- Jennifer Irvin Vidrine
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1440, Houston, TX 77030, USA.
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Grossman E, Shelley D, Braithwaite RS, Lobach I, Goffin A, Rogers E, Sherman S. Effectiveness of smoking-cessation interventions for urban hospital patients: study protocol for a randomized controlled trial. Trials 2012; 13:126. [PMID: 22852878 PMCID: PMC3502597 DOI: 10.1186/1745-6215-13-126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 06/08/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hospitalization may be a particularly important time to promote smoking cessation, especially in the immediate post-discharge period. However, there are few studies to date that shed light on the most effective or cost-effective methods to provide post-discharge cessation treatment, especially among low-income populations and those with a heavy burden of mental illness and substance use disorders. METHODS/DESIGN This randomized trial will compare the effectiveness and cost-effectiveness of two approaches to smoking cessation treatment among patients discharged from two urban public hospitals in New York City. During hospitalization, staff will be prompted to ask about smoking and to offer nicotine replacement therapy (NRT) on admission and at discharge. Subjects will be randomized on discharge to one of two arms: one arm will be proactive multi-session telephone counseling with motivational enhancement delivered by study staff, and the other will be a faxed or online referral to the New York State Quitline. The primary outcome is 30-day point-prevalence abstinence from smoking at 6-month follow-up post-discharge. We will also examine cost-effectiveness from a societal and a payer perspective, as well as explore subgroup analyses related to patient location of hospitalization, race/ethnicity, immigrant status, and inpatient diagnosis. DISCUSSION This study will explore issues of implementation feasibility in a post-hospitalization patient population, as well as add information about the effectiveness and cost-effectiveness of different strategies for designing smoking cessation programs for hospitalized patients. TRIAL REGISTRATION Clinicaltrials.gov ID# NCT01363245.
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Affiliation(s)
- Ellie Grossman
- Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
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Enhancing dissemination of smoking cessation quitlines through T2 translational research: a unique partnership to address disparities in the delivery of effective cessation treatment. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:304-8. [PMID: 20520368 DOI: 10.1097/phh.0b013e3181cbc500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schauer GL, Thompson JR, Zbikowski SM. Results From an Outreach Program for Health Systems Change in Tobacco Cessation. Health Promot Pract 2012; 13:657-65. [DOI: 10.1177/1524839911432931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Washington state has experienced a dramatic reduction in adult smoking prevalence (22.4% in 1999 to 14.8% in 2010) because of a comprehensive tobacco control effort that includes a proactive health professional education and an outreach program. The outreach program uses academic detailing and online tools to increase routine identification and treatment of tobacco users. This article summarizes outcomes from the first 2 years of the program. Method. Outcome measures include the frequency of contact with providers, changes in the percentage of callers reporting that they had heard about the Quit Line from a health professional, and changes in provider Quit Line fax referrals. Data are compared between Initial, Expanded, and Never Outreach Counties. Results. From 2008 to 2010, a total of 629 unique health care organizations and 3,989 unique health professionals received services. Between 2007 and 2010, the ratio of health professional “How Heard Abouts” to total Quit Line registrations increased by 142.6% and 95.4% in Initial and Expanded Outreach Counties, whereas Never Outreach Counties showed an 11.2% increase. Fax referrals to the Quit Line increased by 132% and 232% in Initial and Expanded Outreach Counties whereas they declined by 39% in Never Outreach Counties. Discussion. Results suggests that health professionals can be an important and reliable source of referrals to a treatment resource such as a tobacco quitline. A field-based outreach program using academic detailing principles can be used to increase treatment referrals and holds application for other chronic disease areas and quality improvement programs.
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Affiliation(s)
| | - Juliet R. Thompson
- Washington State Department of Health, Tobacco Prevention and Control Program, Tumwater, WA, USA
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Carpenter KM, Carlini BH, Painter I, Mikko AT, Stoner SA. Refer2Quit: impact of Web-based skills training on tobacco interventions and quitline referrals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:187-195. [PMID: 23008081 DOI: 10.1002/chp.21144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Tobacco quitlines (QLs) provide effective evidence-based tobacco cessation counseling, yet they remain underutilized. Barriers to utilization include the lack of referrals by health care providers who typically have little knowledge about QLs and low self-efficacy for providing tobacco interventions. In order to educate providers about QLs, referral methods and tobacco interventions, a case-based online CME/CE program, Refer2Quit (R2Q), was developed. R2Q includes QL education and intervention and referral skills training tailored to provider type (eg, physician, nurse, dental provider, pharmacist) and work setting (eg, emergency, outpatient, inpatient). A module teaching motivational enhancement strategies was also included. METHODS Four health care organizations in Washington State participated in a study examining the effects of R2Q training on fax referral rates in an interrupted times series. Attitudes and self-efficacy toward delivering tobacco interventions was also assessed. Participants were a mix of provider types, including prescribers (20.1%), RNs (46.7%), and others (33.2%). RESULTS Health care sites that participated in the study increased the fax referral rates (odds ratio [OR] 2.86, confidence interval [CI] 1.52-6.00) as well as rates of referrals that converted to actual quitline registrations (OR 2.73, CI 1.0-7.4). Providers who completed the training expressed significantly more positive attitudes and improved self-efficacy for delivering tobacco services. At follow-up most providers reported increased delivery of tobacco interventions and QL referrals, although only 17% reported increased rates of fax referral. DISCUSSION Our study suggests that online education builds skills, improves knowledge, and thus increases the number and quality of fax referrals made to QLs by health care providers. Providers nonetheless reported ongoing barriers to providing tobacco services and referral, including lack of reimbursement and patient unwillingness to accept a referral.
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Sheffer MA, Baker TB, Fraser DL, Adsit RT, McAfee TA, Fiore MC. Fax referrals, academic detailing, and tobacco quitline use: a randomized trial. Am J Prev Med 2012; 42:21-8. [PMID: 22176842 DOI: 10.1016/j.amepre.2011.08.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/20/2011] [Accepted: 08/30/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy. PURPOSE To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit. DESIGN Participants were randomized to one of two intervention conditions. SETTING/PARTICIPANTS Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month. INTERVENTIONS One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD). MAIN OUTCOME MEASURES Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009. RESULTS Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010. CONCLUSIONS Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT00989755.
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Affiliation(s)
- Megan A Sheffer
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Mathias JS, Didwania AK, Baker DW. Impact of an electronic alert and order set on smoking cessation medication prescription. Nicotine Tob Res 2011; 14:674-81. [PMID: 22180576 DOI: 10.1093/ntr/ntr265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Tobacco cessation medication use increases the likelihood of a successful quit attempt, but few smokers are prescribed medications. Electronic health records (EHRs) may increase cessation medication prescription. This study aimed to assess the impact of an electronic alert and linked order set on cessation medication prescription. METHODS This pre- and postintervention cohort study was conducted in an urban academic general internal medicine practice with a comprehensive EHR. All active smokers with 2 or more visits to the practice in 2008 (preintervention cohort) or 2009 (postintervention cohort) were included. An electronic alert and linked order set were designed and implemented. The primary outcome was prescription of any cessation medication (nicotine replacement therapy, bupropion, or varenicline). Secondary outcomes included counseling referral and change in smoking status to quit during the study period (i.e., "quit rate"). RESULTS There were 1,349 and 1,346 smokers in the pre- and postintervention cohorts, respectively. Cessation medication prescription did not significantly change after the intervention (14.4% vs. 13.4% of smokers in the preintervention cohort, p = .5). Counseling referrals increased from 2.0% to 7.2% in the postintervention cohort (p < .001). More smokers in the postintervention cohort changed their smoking status to quit during the study period (20.5% vs. 17.1%, p = .06). CONCLUSIONS This provider-directed electronic alert and linked order set failed to increase cessation medication prescription. The consistent failure of provider-directed efforts to increase cessation medication use suggests that this is a patient-limited process. Future efforts to improve tobacco treatment should focus on overcoming patient-level barriers to cessation medication use.
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Affiliation(s)
- Jason S Mathias
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Abstract
BACKGROUND Health information systems such as electronic health records (EHR), computerized decision support systems, and electronic prescribing are potentially valuable components to improve the quality and efficiency of clinical interventions for tobacco use. OBJECTIVES To assess the effectiveness of electronic health record-facilitated interventions on smoking cessation support actions by clinicians and on patient smoking cessation outcomes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, and reference lists and bibliographies of included studies. We searched for studies published between January 1990 and May 2011. SELECTION CRITERIA We included both randomized studies and non-randomized studies that reported interventions targeting tobacco use through an EHR in health care settings. The intervention could include any use of an EHR to improve smoking status documentation or cessation assistance for patients who use tobacco, either by direct action or by feedback of clinical performance measures. DATA COLLECTION AND ANALYSIS Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because few randomized studies existed, we did not conduct a meta-analysis. MAIN RESULTS We included three randomized and eight non-randomized observational studies of fair to good quality that tested the use of an existing EHR to improve documentation and/or treatment of tobacco use. None of the studies included a direct assessment of patient quit rates. Overall, these studies found only modest improvements in some of the recommended clinician actions steps on tobacco use. AUTHORS' CONCLUSIONS At least in the short term, documentation of tobacco status and increased referral to cessation counseling do appear to increase following the introduction of an expectation to use the EHR to record and treat patient tobacco use at medical visits. There is a need for additional research to further understand the effect of EHRs on smoking treatment in healthcare settings.
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Affiliation(s)
- Raymond Boyle
- ClearWay MinnesotaSM, Two Appletree Square, 8011 34th Avenue South, Suite 400, Minneapolis, MN, Minnesota, USA, 55425
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Sadasivam RS, Delaughter K, Crenshaw K, Sobko HJ, Williams JH, Coley HL, Ray MN, Ford DE, Allison JJ, Houston TK. Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation. J Med Internet Res 2011; 13:e87. [PMID: 22011394 PMCID: PMC3222193 DOI: 10.2196/jmir.1721] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 06/17/2011] [Accepted: 07/05/2011] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions. OBJECTIVE The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care. METHODS We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings. RESULTS Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider-patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer). CONCLUSIONS Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial. TRIAL Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy).
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01545, USA.
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Faseru B, Turner M, Casey G, Ruder C, Befort CA, Ellerbeck EF, Richter KP. Evaluation of a hospital-based tobacco treatment service: outcomes and lessons learned. J Hosp Med 2011; 6:211-8. [PMID: 21480493 PMCID: PMC3081657 DOI: 10.1002/jhm.835] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 07/02/2010] [Accepted: 07/11/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND The efficacy of smoking cessation interventions for hospital patients has been well described, but we know little regarding implementation and outcomes of real-world programs. OBJECTIVE To describe the services provided and outcomes of an academic medical center-based tobacco treatment service (UKanQuit) located in the Midwestern United States. METHOD This is a descriptive observational study. Both quantitative and qualitative data of all patients treated by UKanQuit over a 1-year period were analyzed. RESULTS Among 513 patients served, average interest in quitting was 7.9, standard deviation (SD) 2.9 on a scale of 0 to 10. More than 1 in 4 had been given an in-hospital medication to ameliorate withdrawal prior to seeing a counselor. Counselors recommended medication changes for 1 in 3 patients, helped 73% set a goal for quitting or reducing tobacco use, and fax referred 56% to quitlines. Six-month follow-up (response rate, 46%) found a 7-day abstinence rate of 32% among respondents for an intent-to-treat abstinence rate of 15%. Post-discharge, 74% made at least one serious quit attempt, 34% had used a quit smoking medication, but only 5% of those referred to the quitline reported using it. CONCLUSIONS In a hospital setting, interest in quitting is high among smokers who requested to see a tobacco counselor but administration of inpatient medications remains low. Many smokers are making unassisted quit attempts post-discharge because utilization of cessation medications and quitline counseling were low. Fax-referral to quitline may not, on its own, fulfill guideline recommendations for post-discharge follow-up.
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Affiliation(s)
- Babalola Faseru
- University of Kansas School of Medicine and University of Kansas Hospital, Kansas City, Kansas, USA.
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Mathew M, Goldstein AO, Kramer KD, Ripley-Moffitt C, Mage C. Evaluation of a direct mailing campaign to increase physician awareness and utilization of a quitline fax referral service. JOURNAL OF HEALTH COMMUNICATION 2010; 15:840-845. [PMID: 21170786 DOI: 10.1080/10810730.2010.522223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Research has shown that fax referral services play an important role in linking people who are ready to quit tobacco use with effective cessation support provided through telephone-based quitlines. While many states have implemented fax referral services to assist health care providers in connecting their patients to quitlines, few published studies delineate optimum ways to promote this service to providers, particularly the role of direct mail educational campaigns. This is one of the first studies to evaluate the effectiveness of a small-scale educational and promotional campaign designed to increase health care providers' awareness and utilization of a state tobacco cessation quitline fax referral service. The campaign included a direct mailing to 6,197 health care providers in North Carolina. The mailing consisted of a large tube, in the shape of cigarette, with enclosed fax referral promotional materials. An 8-month follow-up survey was mailed to a 10% random sample of family physicians, pediatricians, dentists, and orthodontists who were sent the promotional tube mailing. Valid surveys were returned by 271 providers (response rate = 46%). Forty-four percent of respondents remembered receiving the tube mailing, and 40% reported familiarity with the fax referral service. While only 3.5% of respondents reported referring a patient to the quitline using the fax referral service in the previous 6 months, almost one-third reported an intention to use the fax referral service in the future. The pilot promotional campaign increased awareness of the fax referral service more than service utilization. While increased utilization of the service by health care providers appears promising, additional research is needed on how to maximize educational and promotional campaigns that influence clinician fax referral behaviors. The results of this study can help guide the development of future fax referral promotional campaigns to increase clinician access to and utilization of state quitlines.
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Affiliation(s)
- Mary Mathew
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA
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Boyle RG, Solberg LI, Fiore MC. Electronic medical records to increase the clinical treatment of tobacco dependence: a systematic review. Am J Prev Med 2010; 39:S77-82. [PMID: 21074681 DOI: 10.1016/j.amepre.2010.08.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/12/2010] [Accepted: 08/24/2010] [Indexed: 11/17/2022]
Abstract
CONTEXT The expanded use of electronic medical records (EMRs) may provide an opportunity to increase the use and impact of clinical guidelines to promote tobacco-cessation treatment in primary care settings. The objective of this systematic review is to evaluate the evidence for such an effect. EVIDENCE ACQUISITION After a systematic search of the English-language literature regarding an EMR effect on either smoking cessation or clinician behavior, relevant articles were abstracted and findings summarized from both observational studies and RCTs. EVIDENCE SYNTHESIS Of ten identified studies of EMRs and tobacco, only two RCTs were found. Adding tobacco status as a vital sign resulted in an increase in some clinical guideline recommended actions, particularly documentation of smoking status. There was insufficient evidence to quantify the effect of an EMR on changes in patient smoking behaviors. CONCLUSIONS While the use of EMRs to prompt or provide feedback on the clinical treatment of tobacco dependence demonstrates some promising results, substantial additional research is needed to understand the effects of EMRs on provider and patient behavior.
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Rates of enrollment in smoking cessation services following fax referrals from a children's hospital. Acad Pediatr 2010; 10:200-4. [PMID: 20452567 DOI: 10.1016/j.acap.2010.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 02/24/2010] [Accepted: 03/02/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the rates of enrollment in tobacco dependence treatment among smoking adults who accepted a fax referral from health care providers at a children's hospital, and to examine smoker characteristics associated with enrollment. METHODS Secondary analysis of the state-sponsored fax referral and treatment program data on all referrals from Arkansas Children's Hospital in 2005 to 2007 was conducted. Enrollment was defined as attendance at 1 or more counseling sessions within 1 year of referral. Logistic regression analyses were used to identify demographic and tobacco-related characteristics associated with enrollment versus nonenrollment in a treatment program among those contacted by the program. RESULTS Of the 749 faxed referrals to the program, 157 (21.0%) enrolled in a treatment program and received 1 or more treatment sessions; 505 were contacted by the program, and of these, 147 (29%) enrolled. Women were more likely to enroll than men (odds ratio [OR] 1.81; 95% confidence interval [95% CI], 1.09-3.01). Whites were twice as likely to enroll than African Americans (OR 2.35; 95% CI, 1.28-4.33). Older age (OR 1.04; 95% CI, 1.01-1.06) and higher self-efficacy scores (OR 1.13; 95% CI, 1.02-1.26) increased the likelihood of enrollment. CONCLUSIONS Approximately 1 in 5 smokers who accepted a fax referral enrolled in and received intensive treatment services for tobacco dependence. Thus, innovative approaches are needed to increase enrollment among younger, African American, and male smokers.
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