Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

Elizabeth L Albert,India J Gill,Susan A Flocke,Jeanmarie C Rose

doi:10.1186/s12889-020-09185-4

Elizabeth L Albert, India J Gill + Show 2 more

Open Access

https://doi.org/10.1186/s12889-020-09185-4

Copy DOI

Abstract

BackgroundThe use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement.MethodsWe conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017–August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes.ResultsReasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL.ConclusionsParticipants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.

Highlights

The use of electronic referrals to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale
Tobacco smoking accounts for about 1 in 5 deaths in the United States [1], and is more prevalent among those who live below the poverty level [2], making smoking cessation a public health priority [3]
Referral to QLs by health care providers is strongly recommended as an effective strategy for providing tobacco cessation assistance [9,10,11], and dissemination of QL-delivered treatment within the context of a health system has the potential to address smoking cessation on a large scale

Summary

Introduction

The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. Bui et al examined differences in QL enrollment among smokers seeking care at 1 HIV clinic and 12 non-HIV clinics that were part of a large healthcare system in a large metropolitan area. They found that at the non-HIV clinics, 54.5% of referred smokers were later unreachable, and of those reached, 24% declined services; among those seen at the HIV clinic, 55.6% of referred patients were unreachable and 24.9% of those reached declined services [15]. This is significant because research has found that those who complete more of the calls offered in QL programs have higher quit rates than those who complete fewer calls [7, 18, 19]

Objectives

Methods

Results

Discussion

Conclusion