UW-CTRI researchers have identified a new way to treat more people who smoke, to reduce racial and other disparities among those who smoke, and to combat the leading preventable cause of disease and death across the nation.
They did it by taking a holistic approach, targeting all known smokers in a health system, not just the small proportion of patients who are ready to quit immediately when they visit a clinic. As part of this effort, they used multiple strategies to reach out to the many patients who don’t see their doctor regularly, letting them know that there was help available to quit.
To test this novel approach, the UW researchers partnered with a health system in Wisconsin, Group Health Cooperative of South Central Wisconsin (GHC-SCW), to reach out to all their patients known to be smokers and deliver a chronic-care program on an ‘opt-out’ basis to each of them.
Clinic staff known as Tobacco Cessation Outreach Specialists (TCOS) called patients and offered free help to quit smoking, which kills nearly half a million Americans a year. Telephone treatment reach was particularly high in historically underserved groups, including African American, Hispanic, and Medicaid-eligible patients. Researchers published the results in the journal Preventive Medicine.
“The great news is that any healthcare system can implement this approach, using their electronic health record system,” said Dr. Michael Fiore, director of the UW Center for Tobacco Research and Intervention (UW-CTRI) and principal investigator of the study. “They simply identify every patient who smokes and reach out to them regularly to offer treatments, whether they have a doctor visit or not.”
UW-CTRI partnered with GHC-SCW to reach approximately 7,000 of their patients who smoke with frequent messages regarding the importance of quitting to their health.
A key component to the system was having dedicated TCOS who followed up with patients who set quit dates, said Dr. Danielle McCarthy, lead author on the publication and UW-CTRI Co-Director of Research. “They did a terrific job coaching patients on how to quit and ensuring they received medications,” McCarthy said.
During this research intervention, African-American patients received TCOS services at higher rates than did members of other racial groups. Before the program, Hispanic patients got help to quit smoking at significantly lower rates than other patients. This gap was essentially eliminated by the program, and Hispanic patients accepted quitting help at particularly high rates.
UW-CTRI Associate Director Tim Baker noted that, for many years, various medically underserved groups, such as African-Americans and individuals of lower socioeconomic status, have been especially unlikely to participate in smoking cessation treatment.
“This multifaceted EHR-guided approach may be one way to encourage greater treatment participation by all people who smoke,” Baker said.
When the program was active in all six GHC-SCW clinics, 24 percent of adult patients who smoked received some form of smoking treatment – a markedly higher rate than typically seen in health systems. Moreover, roughly 1 in 6 of those reached made a quit plan and accepted quit-smoking medication.
“Our hope is that health systems will see this, reach out to patients who they know smoke, and offer help to quit,” Fiore said. “It’s the best thing they can do for their health.”
The study was funded by the National Cancer Institute, with EHR technical expertise provided by Epic Systems Corporation.
McCarthy DE, Baker TB, Zehner ME, Adsit RA, Kim N, Zwaga D, Coates K, Wallenkamp H, Nolan MB, Steiner M, Skora A, Kastman C, Fiore MC. (2022) A Comprehensive Electronic Health Record-Enabled Smoking Treatment Program: Evaluating Reach and Effectiveness in Primary Care in a Multiple Baseline Design. Preventive Medicine. Online May 28, 2022.