Study: E-Referral to Quit Line Works

Doctor shows patient results on a tablet

New technology can improve the ways in which people who smoke get connected with quitting services; one of the most promising developments has been e-referrals, an electronic referral system that uses secure electronic health records to help people on the road to quitting.

A new study in American Journal of Preventive Medicine takes a deep dive into how effective electronic referral, or ‘e-referral,’ is, and how it can be best implemented. The study found that its use drastically increased both the assessment of a patient’s readiness to quit smoking—from 24.8 percent to 93.2 percent—and the number of patients who agreed to be referred for smoking treatment—1.7 percent to 11.3 percent. It also led to more people contacting the Wisconsin Tobacco Quitline after their referral.

The study collected data from adults who smoke, spread across 30 clinics in the UW Health system that had switched from faxing patient information to quitlines (called ‘Fax referral’) to e-referral.

With e-referral, patients are asked whether they are ready to make an aided quit attempt and, if they are, referred with a few simple clicks. Their information can then be sent to quitlines.

By taking a look at the Electronic Health Records (EHR) sent this way, the study’s authors were able to analyze the ‘reach’ of e-referral, seeing just how many patients were identified as people who smoke, were offered treatment, and got referred.

The study also tested adoption and maintenance: adoption to see how many staff members at the clinics used the new e-referral strategy; and maintenance to see if, over time, staff members continued to use the strategy.

The data showed that the new e-referral strategy was both widely used and also well-maintained.

For adoption, 52.6 percent of clinicians who saw a smoker referred them to the quitline; and for maintenance, while referral rates dropped during a period of eight months, they still stayed above the rates from before e-referral implementation.

“This research builds on the groundbreaking work that Rob Adsit, Danielle McCarthy, and Mike Fiore have done to develop the e-Referral system,” said Dr. Tim Baker, one of the study’s authors.

“Thanks to their work, these systems are now being implemented in healthcare services all over the country.”

The new e-referral system is the next step in connecting people who smoke with valuable quitting services, like the Wisconsin Tobacco Quit Line, and ensuring that, no matter where they are on the road to staying smoke free, they have access to all the help they need.

Baker TB, Berg KM, Adsit RT, Skora AD, Swedlund MP, Zehner ME, McCarthy ME, Glasgow R, Fiore MC. (2021) Closed-loop eReferral from Primary Care Clinics to a State Tobacco Cessation Quitline; Effects Using Real World Implementation Training. American Journal of Preventive Medicine. Volume 60, Issue 3, Supplement 2, March 2021, Pages S113-S122.