Implementing point of care "e-referrals" in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies
Sadasivam, Rajani S ; Hogan, Timothy P. ; Volkman, Julie E. ; Smith, Bridget M. ; Coley, Heather L. ; Williams, Jessica H. ; Delaughter, Kathryn ; Ray, Midge N. ; Gilbert, Gregg H. ; Ford, Daniel E ... show 3 more
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Smoking cessation
Online behavior changesystems
General practice
Family practice
Dentalpractice public health informatics
Randomizedcontrolled trial
Health services research
Behavior and Behavior Mechanisms
Dental Public Health and Education
Health Information Technology
Health Services Administration
Health Services Research
Substance Abuse and Addiction
Translational Medical Research
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Abstract
Integrating electronic referral systems into clinical practices may increase use of web-accessible tobacco interventions. We report on our feasibility evaluation of using theory-driven implementation science techniques to translate an e-referral system (ReferASmoker.org) into the workflow of 137 community-based medical and dental practices, including system use, patient registration, implementation costs, and lessons learned. After 6 months, 2,376 smokers were e-referred (medical, 1,625; dental, 751). Eighty-six percent of the medical practices [75/87, mean referral = 18.7 (SD = 17.9), range 0-105] and dental practices [43/50, mean referral = 15.0 (SD = 10.5), range 0-38] had e-referred. Of those smokers e-referred, 25.3 registered [mean smoker registration rate-medical 4.9 (SD = 7.6, range 0-59), dental 3.6 (SD = 3.0, range 0-10)]. Estimated mean implementation costs are medical practices, US$429.00 (SD = 85.3); and dental practices, US$238.75 (SD = 13.6). High performing practices reported specific strategies to integrate ReferASmoker.org; low performers reported lack of smokers and patient disinterest in the study. Thus, a majority of practices e-referred and 25.3 % of referred smokers registered demonstrating e-referral feasibility. However, further examination of the identified implementation barriers is important as of the estimated 90,000 to 140,000 smokers seen in the 87 medical practices in 6 months, only 1,625 were e-referred.
Source
Sadasivam RS, Hogan TP, Volkman JE, Smith BM, Coley HL, Williams JH, Delaughter K, Ray MN, Gilbert GH, Ford DE, Allison JJ, Houston TK; National Dental PBRN and QUITPRIMO Collaborative Groups. Implementing point of care "e-referrals" in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies. Transl Behav Med. 2013 Dec;3(4):370-8. doi: 10.1007/s13142-013-0230-3. Link to article on publisher's site