Quitline Treatment Enrollment and Cessation Outcomes Among Smokers Linked With Treatment via Ask-Advise-Connect: Comparisons Among Smokers With and Without HIV

Abstract

Introduction Given that people living with HIV (PLWH) are disproportionately burdened by tobacco-related morbidity and mortality, it is critically important to understand the degree to which evidence-based cessation interventions are utilized by and are effective among PLWH. Aims and Methods This secondary data analysis aimed to examine differences in Quitline treatment enrollment and 6-month cessation outcomes among smokers seeking care at 1 HIV clinic and 12 non-HIV clinics that were part of a large healthcare system in the greater Houston, Texas metropolitan area, United States. Data were from a 34-month (April 2013–February 2016) one-group implementation trial that evaluated the Ask-Advise-Connect (AAC) approach to linking smokers with Quitline treatment. Primary outcomes included (1) treatment enrollment and (2) 6-month self-reported and biochemically confirmed abstinence. Results The smoking status of 218 915 unique patients was recorded in the electronic health record; 5285 (2.7%) of these patients were seen at the HIV clinic where the smoking prevalence was 45.9%; smoking prevalence at the non-HIV clinics was 17.9%. The proportion of identified smokers who enrolled in treatment was 10.8% at the HIV clinic and 11.8% at the non-HIV clinics. The self-reported abstinence rate was 18.7% among HIV clinic patients and 16.5% among non-HIV clinic patients. Biochemically confirmed abstinence was lower at 4.2% and 4.5%, respectively (all ps > .05). Conclusions AAC resulted in rates of Quitline treatment enrollment and abstinence rates that were comparable among patients seen at an HIV clinic and non-HIV clinics. Findings suggest that AAC should be considered for widespread implementation in HIV clinics. Implications PLWH were as likely as other patients to enroll in evidence-based tobacco cessation treatment when it was offered in the context of a primary care visit. Cessation outcomes were also comparable. Therefore, standard care for PLWH should include routine screening for smoking status and referrals to cessation treatment.

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

“…"Yes, I would (like to talk to the QL), because it was just a misunderstanding and the wrong moment. (15,17,18). This study expands our understanding of why so many smokers, having accepted a referral during their primary care office visit, later disengage with the QL.…”

“…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% then declined services; similarly, among those seen at the HIV clinic, 55.6% of referred patients were unreachable and 24.9% of those reached declined services (15). In addition to being unreachable or declining QL participation, many smokers do not complete the multiple (3)(4)(5) counseling sessions offered by most QLs (17,18).…”

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

“…"Yes, I would (like to talk to the QL), because it was just a misunderstanding and the wrong (15,17,18). This study expands our understanding of why so many smokers, having Other studies have also found that stressors related to lower SES are a barrier to use of QL counseling (25,26).…”

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

“…There is growing evidence, however, that with this approach, the QL is unable to contact and/or keep enrolled a large percentage of the patients who agree to be connected (12,(14)(15)(16). Adsit et al found that among tobacco users consenting to be eReferred to the QL, 64.8% later declined cessation services (14).…”

“…Adsit et al found that among tobacco users consenting to be eReferred to the QL, 64.8% later declined cessation services (14). Bui et al found that 54.5% of eReferred smokers were later unreachable, and of those reached, 24% then declined services (15). In addition to being unreachable or declining QL participation, many smokers do not complete the multiple (3)(4)(5) counseling sessions offered by most QLs (17,18).…”