Patient Engagement by the Tobacco Quitline After Electronic Referrals.
Thursday, August 18, 2022
Posted by: Natalia Gromov
Khanna N, Klyushnenkova EN,
Quinn D, Wolfe S.
Patient Engagement by the
Tobacco Quitline After Electronic Referrals.
[published online ahead of print, 2022 Aug 5]. Nicotine Tob Res.
2022;ntac190. doi:10.1093/ntr/ntac190
Introduction. Referrals
through the Electronic Health Record (EHR) system provide an efficient
evidence-based method to connect patients to the Tobacco Quitline. However,
patients frequently do not respond to Quitline phone calls or accept services.
The goal of this study was to characterize factors associated with successful engagement
with Quitline following e-referrals by physicians in Maryland.
Methods. This
is a cross-sectional study with hierarchical data modeling. Data for 1790
patients e-referred in 2018-2019 by the University of Maryland Medical System
were analyzed. Patients' engagement was assessed using a Generalized Estimating
Equation multivariable regression model for ordinal outcomes at two levels:
picking up a phone call from Quitline (1-800-QUIT-NOW) and enrollment in
tobacco cessation programs.
Results. Older
age, female gender, Black race, low socioeconomic status, and provider's skills
were significantly associated with successful outcomes of Quitline referral.
The engagement with Quitline was higher in Black non-Hispanic patients compared
to other racial/ethnic groups (phone call response OR=1.99, 95% CI 1.35, 2.93
and service acceptance OR=1.89, 95% CI 1.28, 2.79). Patients residing in
socioeconomically deprived areas were more likely to respond to Quitline phone
call compared to those from affluent neighborhoods (OR=1.52, 95% CI 1.03,
2.25). Patients referred by faculty/attending physicians were more likely to
respond compared to those referred by residents (OR=1.23, 95% CI 1.04, 1.44,
p=0.0141).
Conclusions. Multiple
factors impact successful engagement with Quitline. Additional means to improve
Quitline engagement success may include focused messaging on tobacco cessation
benefits to patients, and skillful counselling by the provider.
Implications. Implementation
of the Clinical Decision Support (CDS) tool for electronic referrals to the
Tobacco Quitline at the University of Maryland Medical System was successful in
providing evidence-based free service to elderly patients and socioeconomically
disadvantaged racial/ethnic minorities. The CDS also served to engage
physicians in conversation about tobacco use and cessation with every tobacco
using patient. Curricular content for physicians in training should be enriched
to expand tobacco use and treatment.
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