Scott Leischow, PhD, who recently left his position at the University of Arizona as Professor in the Colleges of Medicine & Public Health, and Associate Director at the Arizona Cancer Center, to serve in a research capacity at the Mayo Clinic & Hospitals, has worn "quitline shoes” for many years. Did you think we could finish this blog without checking in with him? Of course not. Having focused on tobacco policy and bridging research and practice for so many years we know that Dr. Leischow has seen opportunities for our field come and go – some that we successfully leveraged and others that we did not. We wanted to know what Dr. Leischow had to say about the opportunities on the very near horizon that quitlines must take full advantage of? Here are his thoughts:

Healthcare in the U.S. is evolving in ways that are both predictable and unpredictable, and this has dramatic implications for the quitline community. Predictable changes include the reality that healthcare organizations will continue to increase in size as more physicians and other healthcare workers become employees of large for-profit and non-profit businesses and will provide care in more standardized ways in order to reduce cost and improve quality of care. In addition, the evidence that prevention of disease is fundamental to reducing disease risk and healthcare costs is driving healthcare policy decisions that are exemplified by the provision of prevention services like tobacco treatment at low or no cost to the patient. My sense is that these changes will occur regardless of what happens in the political arena because the evidence shows that they reduce costs. This is very likely to create new opportunities for increasing the role of quitline-based interventions in the evolving healthcare systems. As quality of care indicators and technology structures and functions evolve, there are opportunities to press for care to be provided via mechanisms that are not face-to-face, including via telephone, web, text messaging, etc. And as we have observed in our research on the network of quitlines, innovation in quitline practices will continue to foster improvements in tobacco treatment. Moreover, those changes will likely create new opportunities and perhaps even requirements to address tobacco use in the context of other health issues such as obesity and mental illness.

But there is unpredictability as well. One of the fundamental challenges to the quitline community as the healthcare and technology environments evolve together is the role of ‘discovery’ (i.e., research) in understanding what works and doesn’t for different populations and in different environments. Our work has shown that interaction with scientists impacts the awareness of evidence-based practices in the quitline community, and without that awareness the adoption of evidence-based and evolving practices will likely be slowed. (To learn more about the Knowledge Integration in Quitlines: Networks that Improve Cessation (KIQNIC) study, visit http://www.naquitline.org/?page=kiqnic.)However, funding for new discovery by NIH has stagnated and even decreased, so while building a solid discovery linkage to quitlines will be a challenge, it also creates opportunities for quitlines to work together to develop real-world solutions to discovering how to improve care. Developing ways that quitlines can share their work and outcomes that have minimal cost and potential gain is, in my view, an essential near-term need that will help to assure the viability and centrality of quitlines in the treatment of tobacco dependence. For example, we have found that certain quitlines tend to be ‘brokers’ of information, and function as hubs of knowledge that benefit other quitlines. Understanding and optimizing how those interactions can improve quality of care are important. (Want to learn more about the KIQNIC study and what researchers have learned so far? Come to the semi-facilitated networking session, Making Use of KIQNIC Data: What Have We Learned and Why Does it Matter?, on Monday, August 13^th at the NAQC Conference!)Of course, many challenges and barriers exist for accomplishing this, not least of which is the competitive nature of quitline services in the U.S. and concerns among some quitlines that sharing information could be used by a ‘competitor’ or those with a desire to defund quitlines. At the same time, in an environment of greater emphasis on transparency, quality of care, and improved treatment outcomes, the way that quitlines function will likely need to evolve or risk stagnation that could reduce their relevance in the changing healthcare environment.

In sum, the synergies of changing healthcare and technology environments will likely benefit quitline evolution by creating new opportunities to make quitlines a more central player in the healthcare environment. This could very well lead to fundamental changes in quitlines as we have known them, perhaps by fostering consolidation of quitlines so that multiple states have a single quitline, increased and improved reporting of treatment outcomes, expansion to address other health issues, and greater implementation of new technologies that might make ‘quitline’ as a descriptor inadequate – all in the context of increased uncertainty regarding funding for both core services and new discovery needed to improve quality of care and outcomes. We are fortunate to have an organization like NAQC to help us navigate the evolution of the quitline environment and to foster communication that helps make the quitline community greater than the sum of its parts.

What are the opportunities you see coming our way that seem critical to the success and evolution of quitlines? How do we best leverage these?