Specialty Clinic Protocol Improves Tobacco Quit Line Referrals
Gap in Specialty Care
Click here to access the Quit Connect video to see hour medical assistant and nursing protocols can close gaps in <2 minutes.
In a previous study, we reported that only 10% of notes from eligible RA clinic visits documented cessation counseling, and only one in 175 notes recommended quit line phone services. Quit line services are free in every state and recommended by US guidelines to improve quit rates, and the Ask-Advise-Connect model has been shown to increase the proportion of patients being referred to quit lines 13-fold. However, these resources are rarely leveraged in rheumatology or other specialty clinics, and the existing models used in primary care have not been tailored for specialty clinics.
Specialty clinic visits outnumbered primary care visits in the United States in 2013, and specialty physicians outnumber primary care physicians. As such, specialty clinics have the opportunity to improve smoking cessation rates for patients with chronic conditions.
How was it developed?
The Quit Connect clinic protocol was developed by a multidisciplinary team at three rheumatology clinics at a large academic health system. We conducted a participatory work system redesign to develop the protocol using focus group sessions with staff medical assistants (MAs) and nurses to (a) assess current processes and needs, and (b) develop a streamlined electronic health record-based quit line referral process. Diverse community partners have also supported this process.
Does it work?
Quit Connect implementation improved quit line referrals from specialty clinics by 20-fold.
In the Quit Connect pilot study, at week 6, the protocol increased tobacco status documentation to 97%, documentation of 30-day readiness to quit increased from 3% to 76% and 32% of those asked reported readiness in the next 30 days.
Overall, 12% of patients who smoked agreed to the quit line electronic referral versus 0.6% being offered the referral prior to the intervention—a 20-fold increase in quit line referrals.
About the Quit Connect Toolkit
Our free downloadable toolkit contains the following materials:
- Quit Connect Manual
- Overview Slides on the Intervention
- EHR Build Guide
- Training Slides for Staff
- Training Handout for Staff
- Medical Assistant/Nurse Instructions
- Patient Brochure
Link to Tobacco Toolkit: https://www.hipxchange.org/QuitConnectHealth