Clinician perceptions of factors influencing referrals to a smoking cessation program

Abstract

BackgroundReferral of patients to smoking cessation telephone counseling (i.e., quitline) is an underutilized resource by primary care physicians. Previously, we conducted a randomized trial to determine the effectiveness of benchmarked feedback on clinician referrals to a quitline. Subsequently, we sought to understand the successful practices used by the high-referring clinicians, and the perceptions of the barriers of referring patients to a quitline among both high and non-referring clinicians in the trial.MethodsWe conducted a qualitative sub-study with subjects from the randomized trial, comparing high- and non-referring clinicians. Structured interviews were conducted and two investigators employed a thematic analysis of the transcribed data. Themes and included categories were organized into a thematic framework to represent the main response sets.ResultsAs compared to non-referring clinicians, high-referring clinicians more often reported use of the quitline as a primary source of referral, an appreciation of the quitline as an additional resource, reduced barriers to use of the quitline referral process, and a greater personal motivation related to tobacco cessation. Time and competing demands were critical barriers to initiating smoking cessation treatment with patients for all clinicians. Clinicians reported that having one referral source, a referral coordinator, and reimbursement for tobacco counseling (as a billable code) would aid referral.ConclusionFurther research is needed to test the effectiveness of new approaches in improving the connection of patients with smoking cessation resources.Trial Registration NumberClinicaltrials.gov NCT00529256

Maximising the value of combining qualitative research and randomised controlled trials in health research: the QUAlitative Research in Trials (QUART) study – a mixed methods study

“…132 In other studies, we could see that the trial offered access to a group of people that might otherwise be hard to identify for qualitative research, 135 that the data collected in the trial were rich enough to allow secondary analysis to explore issues of concern to carers 133 and that researchers had an unanswered question when the trial ended which was addressed by returning to trial participants. 134 There was no doubt that researchers were attempting to address research gaps and made convincing arguments for the need for their research. These articles contributed to the wider knowledge base in terms of understanding more about users' experiences of a service 136 and offering implications for clinical practice.…”

Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults

“…A dult smoking prevalence fell 2 percentage points from 17% in 2014 to 15.3% in 2015 (age adjusted). 1 Yet 42 million adults continue to smoke, 2 and in 2015, 1.6 million middle-and high-school students self-reported smoking tobacco in the last 30 days.…”

“…Tobacco counseling competes with treatment of acute symptoms, management of multiple chronic diseases, and other preventive services, as well as suggestions to integrate clinical practice with community health organizations and to coordinate with community health workers to address patients' social determinants of health. [11][12][13][14][15][16][17][18][19][20] Yarnall and colleagues estimated that a physician with a panel of 2,500 patients would need 7.4 hours per day to deliver evidence-based preventive services 21 and as many as 10.6 hours to provide disease management for chronic conditions. 22 Though Altschuler et al estimated that a physician could care for a panel of 2,000 patients with the maximum feasible delegation of preventive services and chronic disease care to other primary care team members, 23 that level of delegation may be a long time coming.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…GPs who have undertaken a smoking cessation training programme are more effective in promoting smoking cessation. 246 Proactive telephone quitlines are effective, 247 but their availability, GP referral rates, 248,249 and uptake, varies. 250,251 Internetbased smoking cessation strategies are in their infancy: while access is an advantage, uptake and utilisation remain problematic.…”