Implementing a Staff-Led Smoking Cessation Intervention in a Diverse Safety-Net Rheumatology Clinic: a pre-post scalability study in a low resource setting.

Abstract

Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a predominantly White academic healthcare system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety-net rheumatology clinic with a predominantly Black population. In this pre-post study, adult rheumatology visits were analyzed 12 months pre- through 18 months post-QC intervention (November 2019 - November 2021, omitting COVID-19 peak April-Nov 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre-post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost effectiveness was also assessed. Visit-level patients who smoked were 89.8% Black and 69.5% women (n=550). Pre-intervention, clinic staff rarely asked patients about readiness to cut back smoking (< 10% assessment). Post QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% pre); 58.9% of these endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4-10. In a safety-net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness-to-quit assessment, and referrals and was also feasible and cost-effective.