Rheumatology clinics provide an opportunity to address smoking
medwireNews: Protocols for discussing smoking habits, attitudes, and risks in rheumatology clinics may increase referral rates to US state-run tobacco quit lines, research suggests.
“Although smoking is a risk factor for patients with rheumatic conditions and contributes to greater symptom severity and cardiovascular disease risk, standard smoking cessation intervention is rare in rheumatology clinics,” explain Christie Bartels (University of Wisconsin School of Medicine and Public Health, Madison, USA) and co-authors.
The team therefore devised Quit Connect, an electronic health record e-referral protocol for rheumatology medical assistants and nurses to offer tobacco quit line referrals. The protocol consisted of two prompts: the first to check patients’ tobacco use and readiness to quit smoking within 30 days as well as outline the benefits of quitting on disease activity, and the second to offer quit line resources, including counseling and nicotine replacement within a week, to those ready to stop smoking.
The researchers analyzed data from 54,090 visits that took place across three rheumatology clinics during a 6-month intervention period and during a 4-year control period before the program was implemented.
The rate at which staff assessed patients’ readiness to quit smoking increased by a significant 132-fold after the introduction of Quit Connect compared with before, the researchers report.
Among 523 visits with rheumatology patients who currently smoked, 122 patients were identified as ready to quit smoking using the Quit Connect protocol and 76.2% were offered a referral to a quit line. This equated to 17.8% of current smokers overall, which was a 26-fold increase on the 0.6% of current smokers offered a referral prior to the introduction of Quit Connect.
The majority (71.0%) of the 93 patients offered a referral, which included counselling, 2 weeks of free nicotine replacement, and help setting a quit date, accepted. Of these patients, nearly a quarter (24.2%) set a quit date, “suggesting efficient use of resources,” say Bartels and co-authors, and counselling and nicotine replacement were each accepted by 16.7% of patients.
The investigators point out that “[f]easibility and acceptability were highly rated by clinic staff,” who reported an 80% increase in self-efficacy to address smoking with patients and took an average 90 seconds to complete the Quit Connect protocol.
Bartels et al conclude in Arthritis Care & Research: “Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run [tobacco quit line]. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating protocols like Quit Connect that leverage [tobacco quit lines].”
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