Patient Engagement by the Tobacco Quitline after Electronic Referrals.
Thursday, January 19, 2023
Posted by: Natalia Gromov
Khanna N, Klyushnenkova EN,
Quinn D, Wolfe S.
Patient Engagement by the
Tobacco Quitline after Electronic Referrals.
Nicotine Tob Res. 2023 Jan 1;25(1):94-101. doi: 10.1093/ntr/ntac190. PMID:
35931088.
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.
Aims and 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
(UMMS) 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 odds ratio [OR] = 1.99, 95%
confidence interval [CI] = 1.35% to 2.93% and service acceptance OR = 1.89, 95%
CI = 1.28% to 2.79%). Patients residing in socioeconomically deprived areas
were more likely to respond to Quitline phone calls compared to those from
affluent neighborhoods (OR = 1.52, 95% CI = 1.03% to 2.25%). Patients referred
by faculty or attending physicians were more likely to respond compared to
those referred by residents (OR = 1.23, 95% CI 1.04, 1.44, p = .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 counseling by the provider.
Implications. Implementation
of the clinical decision support (CDS) tool for electronic referrals to the
Tobacco Quitline at the UMMS was successful in providing evidence-based free
service to elderly patients and socioeconomically disadvantaged racial and
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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