Rheumatology clinic boosts smoking cessation referrals 20-fold with Quit Connect program
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Key takeaways:
- A total of 102 out of 550 rheumatology patients who smoked accepted referral to cessation resources as part of the program.
- Each quit attempt cost the clinic $4 to $10.
A rheumatology clinic initiative to connect patients with smoking cessation resources was feasible, cost-effective and boosted referrals to the state quit line 20-fold, according to data published in Arthritis Care & Research.
The initiative, called Quit Connect, used electronic health record prompts that encouraged clinic staff to check patients’ readiness to quit, advise them on the health benefits and refer them to either the state quit line or a smoking cessation class.
“Smoking rates are often higher among persons with [rheumatoid arthritis] and [systemic lupus erythematosus] compared with peers without rheumatic disease,” Jennifer Brandt, MD, MPH, of the Emory University School of Medicine, in Atlanta, and colleagues wrote. “In addition to smoking being a cardiovascular risk factor, it can increase disease severity and predict treatment-refractory disease for both RA and SLE.
“Unfortunately, in a 2023 report, only one-third of patients reported they were given advice or help to quit by their rheumatologist or any other health professionals,” they added.
In a prior validation study, Brandt and colleagues reported that the Quit Connect initiative increased quit line referrals 26-fold in a large academic health care center with predominantly — more than 85% — white patients. For further support, Brandt and colleagues implemented the program in a safety-net rheumatology clinic with a predominantly Black — 79.5% — patient population.
Enacting the program involved 20-minute pre-implementation staff meetings, a 1-hour training session, building EHR reminders and a monthly audit for staff feedback. The researchers analyzed all adult rheumatology visits in the 12 months pre-intervention and 18 months post-intervention — November 2019 to November 2021 — minus the period from April 2020 through November 2020 due to the COVID-19 pandemic.
Prior to the intervention, clinic staff inquired about readiness to quit smoking less than 10% of the time, according to the researchers. That increased to 31.8% of the time post-intervention, to which 58.9% of patients expressed readiness to cut back or quit — an increase from pre-implementation of nearly 50 percentage points.
Of 550 patients who smoked, 102 (18.5%) accepted referrals to either the quit line or a cessation class. Among 83 people contacted by the quit line, 46 (55%) were reached, 17 (37%) of whom set a quit date or reported an attempt to quit in progress.
According to the researchers, the likelihood of patients being referred to either the quit line or cessation class increased more than 20-fold after the intervention (adjusted OR = 20.7; 95% CI, 8.96-47.59). The cost-effectiveness analysis determined a low-end estimate of $4.25 in clinic costs per quit attempt, and a higher-end estimate of $10.28 per attempt.
“Within 3 months, Quit Connect significantly increased referrals to a tobacco quit line and cessation class and was sustained over 2 years despite the COVID-19 pandemic,” Brandt and colleagues wrote. “Success replicated prior positive findings at two Midwest centers with very different populations and resources.
“Our findings support use of the Quit Connect as a scalable public health strategy in other systems, including safety-net or underserved settings,” they added.
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Brandt J, et al. Arthritis Care Res. 2024;doi:10.1002/acr.25349.
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