Physicians recognized as ‘tobacco cessation champions’ for referrals
Physicians in Maryland have been recognized for electronically referring tobacco-smoking patients to quitline resources, a study in the Annals of Family Medicine reported.
Researchers attributed the physicians’ success to positive reinforcement, including letters and certificates acknowledging their referral efforts.
“Tobacco use is one of the most preventable causes of morbidity and mortality in the United States,” Michael Dark, DrPH, MA, a clinical research manager at the University of Maryland in Baltimore, and colleagues wrote. “However, a failure to consistently implement smoking interventions in health care settings is a major impediment to reducing smoking prevalence in clinic populations.”
Previous research has demonstrated that electronic referrals can lead to more positive health outcomes for patients. According to a 2021 study in the American Journal of Preventive Medicine, an e-referral intervention in 30 primary care clinics in Wisconsin led to an increase in the percentage of patients who expressed a readiness to quit, which rose from 24.8% before implementation to 93.2% after implementation. In addition, quitline referrals increased from 1.7% to 11.3%.
For the current study, Dark and colleagues examined whether positive reinforcement can encourage physicians to refer patients to smoking cessation resources. The initiative was conducted at the University of Maryland Medical System, which consists of 12 hospitals and 150 ambulatory clinics.
More than 500 physicians, practitioners and staff were shown how to use e-referrals, the researchers wrote. They were educated about electronic health record workflows, tobacco treatment options, tobacco and e-smoking devices and tobacco cessation pharmacotherapeutics.
Dark and colleagues noted that physicians who e-referred 10 or more patients over a 12-month span were known as “tobacco cessation champions,” while those who e-referred fewer than 10 patients were “tobacco cessation advocates.”
As a reward for their work, physicians were given a letter and certificate celebrating their achievements. They were also encouraged to inspire colleagues to increase e-referrals for patients who smoke.
The researchers found that 264 physicians e-referred patients to the Maryland Quitline, with the Quitline receiving 203 e-referrals in the fourth quarter of 2021 and 269 e-referrals in the first quarter of 2022.
“There were also 443 referrals to the Tobacco Health Practice in 2021,” they wrote.
Dark and colleagues explained that positive reinforcement and acknowledgement of physician and practitioner efforts to improve patient health may increase the prevalence of tobacco cessation e-referrals, with participating physicians self-reporting an enthusiasm for being acknowledged.
The study also demonstrated how “access to accurate EHR data can be a valuable tool in quality improvement to improve clinical outcomes in vulnerable populations,” they wrote.
The researchers pointed out that positive reinforcement initiatives for physicians could also be developed in other areas, while future research should consider proportions of patients who smoke and those who do not require referrals.
“Utilizing the rate of eligible smokers who need and are referred for treatment may produce a more accurate representation of physician/practitioner treatment efforts,” they noted.
References:
- Baker T, et al. Am J Prev Med. 2021;doi:10.1016/j.amepre.2019.12.026.
- Dark M, et al. Ann Fam Med. 2022;doi:10.1370/afm.2891.
- Positive reinforcement can spur physicians and health practitioners to promote tobacco cessation. https://www.eurekalert.org/news-releases/972636. Published Nov. 29, 2022. Accessed Dec. 2, 2022.