Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals
Saturday, June 19, 2021
Posted by: Natalia Gromov
Bartels CM, Johnson L,
Ramly E, Panyard DJ, Gilmore-Bykovskyi A, Johnson HM, McBride P, Li Z, Sampene
E, Lauver DR, Lewicki K, Piper ME.
Impact of a Rheumatology
Clinic Protocol on Tobacco Cessation Quit Line Referrals.
Arthritis Care Res (Hoboken). 2021 Apr 6. doi: 10.1002/acr.24589. Epub ahead of
print. PMID: 33825349.
Objective.
Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco
cessation intervention is rare in rheumatology clinics. This study aimed to
implement a rheumatology staff-driven protocol, Quit Connect, to increase the
rate of electronic referrals (e-referrals) to free, state-run tobacco quit
lines (TQL).
Methods.
We conducted a quasi-experimental cohort study of Quit Connect at three
rheumatology clinics comparing TQL referrals from four baseline years to
referrals during a six-month intervention period. Nurses and medical assistants
were trained to use two standardized electronic health record (EHR) prompts to
Check readiness to quit smoking within 30 days, Advise cessation, and Connect
patients using TQL e-referral orders. We used EHR data to examine the primary
outcome of TQL referrals using pre-post design.
Results.
Across 54,090 pre- and post-protocol rheumatology clinic visits, 4,601 were
with current smokers. We compared outcomes between 4,078 eligible
pre-implementation visits and 523 intervention period visits.
Post-implementation, the odds of TQL referral were 26-fold higher compared to
our pre-implementation rate (unadjusted OR 26, CI 6-106). Adjusted odds of
checking readiness to quit in the next 30 days increased over 100-fold compared
to pre-implementation (adjusted OR 132, CI 99-177). Intervention led to e-referrals
for 71% of quit-ready patients in <90 seconds; 24% of referred patients
reported a quit attempt.
Conclusion.
Implementing Quit Connect in rheumatology clinics was feasible and improved
referrals to a state-run TQL. Given the importance of smoking cessation to
reduce cardiopulmonary and rheumatic disease risk, future studies should
investigate disseminating cessation protocols like Quit Connect that leverage
TQLs.
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