The Ask–Advise–Connect Approach for Smokers in a Safety Net Healthcare System

Abstract

Background Since smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The US Public Health Service recommends that all patients be asked about their smoking at every visit, and that smokers be given brief advice to quit and referred to treatment. Purpose Initiatives to facilitate these practices include the 5 A’s (i.e., Ask, Advise, Assess, Assist, Arrange) and Ask Advise Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask Advise Connect (AAC) approach to linking smokers with treatment in a large, safety-net public healthcare system. Design Pair-matched-two-treatment arm group-randomized trial. Setting/participants Ten safety-net clinics in Houston, TX. Intervention Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed Vocational Nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record (EHR). Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas Quitline daily, and patients were proactively called within 48 hours. In AAR, smokers were offered a Quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. Main Outcome Measure The primary outcome – impact – was defined as the proportion of identified smokers that enrolled in treatment. Results The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t (4) = 14.61, p = 0.0001, OR = 32.10 (95% CI 16.60–62.06). Conclusions AAC has tremendous potential to reduce tobacco-related health disparities.

Dental Students’ Attitudes Toward Tobacco Cessation in the Dental Setting: A Systematic Review

“…31,32,47,53,58 Students in several studies were more likely to ask and advise about tobacco use than engage in the other 5 As (assess, assist, arrange). 72 In Ask-Advise-Connect, the patient completes a form during the health care visit and the provider submits information directly to the quitline through an electronic or faxed system. 72 In Ask-Advise-Connect, the patient completes a form during the health care visit and the provider submits information directly to the quitline through an electronic or faxed system.…”

Increased Evidence-Based Tobacco Treatment Through Oklahoma Hospital System Changes

“…The goal of this initiative is to identify hospitalized tobacco users and those in hospital-affiliated outpatient clinics, assess their readiness to make a quit attempt, and refer them to the Oklahoma Tobacco Helpline. Prior studies [12][13][14] have demonstrated that tobacco-cessation referral programs delivered through hospitals and clinics reach substantial numbers of tobacco users and effectively link them to quitline services. This paper describes the implementation of the OHA hospital-based intervention and quitline referral initiative, Hospitals Helping Patients Quit.…”

The Clinical Effort against Secondhand Smoke Exposure (CEASE) California: Implementing a Pediatric Clinical Intervention to Reduce Secondhand Smoke Exposure

“…More research needs to be done utilizing electronic health record (EHR) to support implementation of CEASE and to support clinicians' ability follow-up with identified smokers. Other studies have shown that EHR integration can increase referral rates to Quitlines [15][16][17], suggesting that integrating tobacco treatment into EHRs is a high yield area for intervention. In addition, this study did not incorporate patient perspectives on screening and smoking support strategies, more research is needed to incorporate diverse patient perspectives further inform effective smoking cessation support interventions to improve interventions and address health disparities.…”