Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Abstract

Objective Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff‐driven protocol, Quit Connect, to increase the rate of electronic referrals (e‐referrals) to free, state‐run tobacco quit lines. Methods We conducted a quasi‐experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6‐month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e‐referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design. Results Across 54,090 pre‐ and post‐protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre‐implementation visits and 523 intervention period visits. Post‐implementation, the odds of tobacco quit line referral were 26‐fold higher compared to our pre‐implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6–106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100‐fold compared to pre‐implementation (adjusted OR 132 [95% CI 99–177]). Intervention led to e‐referrals for 71% of quit‐ready patients in <90 seconds; 24% of referred patients reported a quit attempt. Conclusion Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state‐run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.

2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

“…Individuals with RA who currently use tobacco should be supported in their tobacco cessation journey. The limited efficacy of counseling on tobacco cessation (20) illustrates why it is critical for all members of the interprofessional care team to engage in this practice, which is an existing clinical quality measure (25). There was not sufficient evidence to establish more specific recommendations for tobacco use screening and cessation in RA.…”

Cigarette smoking is associated with decreased long-term treatment cessation of mycophenolate mofetil and methotrexate in cutaneous lupus erythematosus

“…Clinicians can employ smoking cessation strategies on current smokers, which have been successfully implemented in patients with rheumatoid arthritis and other conditions. 7,8 Future prospective studies including a larger cohort with multiple CLE subtypes would help confirm these findings.…”

Rheumatology Clinic Staff Needs

“…This strategy has already demonstrated success in one quasi-experimental cohort study, where a clinic staff-led protocol for smoking cessation increased tobacco quit line referrals 26-fold. 34 When clinical staff counseled patients about smoking, staff confidence was often influenced by their personal smoking cessation experience. Prior literature suggests that nurses and medical assistants are more likely than physicians to be current or former smokers.…”

“…For example, staff's low confidence in communication strategies were subsequently addressed through our BP and quit connect interventions leveraging education, training, modeling, and enablement. 34 As with any study, we acknowledge limitations. First, we recruited from only 2 health systems, although this did encompass both academic and community practice.…”