Background/Purpose: Smoking remains the leading preventable cause of US mortality and predicts higher incidence, greater severity, and reduced treatment response in many rheumatologic conditions. Despite increased risk, few scalable rheumatology clinic interventions exist to support cessation; yet, all states have free tobacco quit lines. Our objective was to examine the impact of our 90-second electronic health record (EHR)-supported staff tobacco cessation protocol on state quit line referral rates in a community rheumatology clinic.

Methods: Using a pre-post implementation design, we implemented and evaluated our EHR-supported staff tobacco cessation protocol called Quit Connect with medical assistants at a community rheumatology practice between May 2015 and April 2018. The protocol included electronic health record prompts to Ask (assess smoking status and 30-day readiness to quit or cut back), Advise to quit and electronically Connect those willing to receive quit line support. Data sources included manually abstracted baseline data and post-implementation EHR protocol documentation. Clinic staff received a one-hour training session on the protocol components and monthly feedback on their fidelity. The effectiveness of the implementation was examined through manually abstracted EHR data using standardized manuals to determine delivery protocol components per patient visit (e.g. advice given, follow-up offered and quit line referrals). Post-implementation quit line referrals were compared to abstracted baseline rates using odds ratios (OR) with 95% confidence intervals.

Results: At baseline (n=100 visits with active smokers), tobacco use discussion was documented by providers 26% of the time. In 17% of these visits, cutting back or quitting was advised. Follow-up or referral to the quit line was never documented, although at three visits (3%), primary care follow up was advised.

Post-implementation, tobacco status was recorded at 5031 of 5117 visits (98%). Readiness to quit was asked at 595 of 607 visits (98%) with smokers. Among those asked, 129 (22%) expressed readiness to quit. Compared to baseline, where 3% (3/100) were recommended any follow up, post-intervention, 31% of smokers who were ready to quit (40/129) were offered referral to the quit line (OR 14.5, 95% CI 4.3-48.6, p<0.0001). Of these, 93% (37/40; 28% of ready smokers) accepted referral. Challenges included >50% turnover of staff. Despite this, usual clinic and float staff were able to implement this protocol.

Conclusion: We demonstrated that Quit Connect, our 90-second staff tobacco cessation protocol, resulted in a 14-fold increase in referrals to the quit line in a community rheumatology clinic. Nearly one in four patients were ready to quit. Engaging staff to implement the protocol resulted in improved referral rates despite high staff turnover. Future studies should investigate scaling cessation protocols with rheumatology staff in diverse clinics to leverage free, state quit lines.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementing-a-staff-tobacco-cessation-protocol-increases-quit-line-referrals-in-a-community-rheumatology-practice/