There are many workflows that can connect patients who use tobacco with external services offering evidence-based tobacco use treatments, such as state tobacco quitlines or Smokefree.gov resources.
Proactive referrals through electronic orders (eReferrals) to a state tobacco quitline, automated texting programs like SmokefreeTXT, or web-based resources like Smokefree.gov can connect patients with free tobacco treatment they can access anytime and anywhere. Many quitlines offer free nicotine replacement medication along with individual, group, or digital psychosocial support. Some quitlines also have special programs for special populations (e.g., American Indian clients, socioeconomically disadvantaged clients) and offer services in many languages. Your cancer care team can promote referral to programs to encourage patients to follow through with treatment.
External eReferrals can complement point-of-care or internal programs, or can be used as a stand-alone treatment if resources are limited. In either case, it is important to design systems that will prompt proactive referral offers or orders for all patients who use tobacco. Such offers can occur at the point of care or in other ways. For example:
- Nurses, medical assistants, or social workers can integrate referral to external tobacco treatment resources (e.g., quitlines, Smokefree.gov) into workflows.
- Mailed or EHR portal outreach messages can be sent to patients on a tobacco use registry to encourage use of tobacco treatment.
- Electronic tools (e.g., pre-appointment text messages, after-visit summary patient instructions) can invite patients to self-refer to tobacco treatment.
- Automated phone or text programs can offer support and follow up with patients who initiate tobacco treatment with warm transfers to other services such as quitlines.
See the Case Studies and this article for an example of C3I programs that utilized an external referral method for providing tobacco treatment. Detailed build guides for eReferral are also available.
For more information on workflows for external referrals, click here.