Prevalence and predictors of quitline enrollment following hospital referral in real-world clinical practice

Abstract

Tobacco quitlines are effective, and work best for callers who receive three or more counseling sessions. Clinical settings are adopting quitline referral as a method for providing cessation support but little is known regarding enrollment and engagement following these referrals. We used data from quitline fax-back reports to describe enrollment and treatment engagement of 878 hospitalized patients who smoke who were referred via secure email to quitline at discharge. We compared patient demographics, tobacco characteristics, and treatment engagement between those enrolled and not enrolled. We conducted chi-square and t-tests to determine which variables should be included in a logistic regression to determine predictors of quitline enrollment. We did not receive fax-back reports for 25% (n = 221) of referred patients; these were excluded from all but the intent-to-treat analysis. Among patients for whom we received reports, 20.4% enrolled and accepted at least one service from the quitline. Among the 79.6% (n = 523) of patients who smoke not enrolled, most (78.3%; n = 410) were classified by the quitline as unreachable. Age (p = .006), smoking within 30 min of waking (p = .005), and interest in quitting (p = .008) were significant predictors of quitline enrollment. Using an intent to treat analysis, 11.4% (n = 100) of all referred patients were enrolled and accepted a single or multi-call programs; 4.2% (n = 37) of all referred patients enrolled and accepted a multi-call counseling program. Quitlines are a pillar of U.S. tobacco treatment. For quitlines to fulfill their potential, quitlines and hospitals must identify effective strategies for reaching and treating referred patients who smoke. Quitlines are effective and are readily available to many in advanced economy countries. Treatment engagement appears to be a barrier to quitline participation as we found few patients who were referred to the quitline actually enrolled in care. Quitlines should consider adopting alternative methods for reaching patients who smoke. Future research is warranted to determine effective solutions to breakdowns in transitions of care.