Introduction

Physicians have unparalleled access to smokers and over 70% of smokers visit a physician every year—providing a unique, powerful opportunity to promote tobacco cessation by asking about smoking behavior and providing cessation advice and counseling to users at every visit. Smokers consider a physician’s advice to quit as an important motivator for smoking cessation and evidence has shown that a physician’s motivational counseling is effective in promoting smoking cessation, with national clinical practice guidelines generally advising the use of brief counseling in which asking about tobacco use is followed by advice to quit. However, despite existing evidence, activation of health care providers to refer patients who use tobacco to cessation services has been a notable challenge for decades but has become more feasible as technologies for electronic health records have evolved. Primary care receipt is well-recognized as the most important point of healthcare contact for tobacco users, and recent research shows that work in healthcare settings is an effective way to activate providers for delivery of cessation services, even during e-visits.

The purpose of this program is to conduct a system change to facilitate the integration of Quitxt into the healthcare setting of the Primary Care Center (PCC) and the Mays Cancer Center (MCC) at UT Health San Antonio, to increase accessibility and utilization of a bilingual, evidence-based tobacco cessation service among patients.

Methods

We adapted our Quitxt program to the patient population attending the PPC and MCC, integrated it into EPIC, our electronic health record system, and added it to the BestPractice Advisories Banner. All patients are screened for tobacco use, and if a tobacco-using patient is identified, the BestPractice Advisories banner appears on HCPs’ screen, prompting them to counsel patients to quit, offer nicotine replacement therapy if needed,  and encourage them to enroll in Quitxt. Enrollment cards are available in exam rooms and help providers talk about the program and provide information on how to enroll. The EPIC system also places instructions on how to enroll in Quitxt in the patients’ after-visit summary in their preferred language. When HCP’s check Quitxt it activates our Patient Navigators (PNs) follow-up. PNs contact patients monthly and provide support, positive reinforcement, and encouragement. They continue with monthly follow-ups throughout the duration of the program. 

Results

To date, 194 patients have been referred to the Best Practice basket. PNs made 829 follow-up phone calls. Of those patients, 104 have enrolled in the program. So far, 96% are English speakers, with a mean age of 47 yrs (SD 11.4). Of those responding to intake questions, 64% were female, 38% Hispanic, the mean number of cigarettes smoked per day was 12, and 60% were ready to make a quit attempt the next day.

Preliminary results from data available show cessation rates of 22.1% at day 1, 26.2% at 7 days, 20.4% at 1 month, 31.4% at 4 months, and  27.6% at 6 months.

Conclusion

Integrating Quitxt into the healthcare setting increases the accessibility and utilization of the Quitxt cessation service among primary care and cancer patients. Quitxt can be easily replicated and represents an affordable approach to reach tobacco-using patients, produce a public health impact, and reduce health service costs and tobacco-related diseases and mortality.