Electronic referrals to the tobacco Quitline: implementation strategies in a large health system to optimize delivery of tobacco cessation to patients
Electronic referrals to the tobacco Quitline: implementation strategies in a large health system to optimize delivery of tobacco cessation to patients
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DOI：
10.1093/tbm/ibaa094
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发表时间：
2021-01-07
影响因子：
3.6
通讯作者：
Wolfe, Sara
中科院分区：
文献类型：
--
作者：
Khanna, Niharika;Klyushnenkova, Elena;Wolfe, Sara
电子转诊为临床医生提供了一个有效的解决方案，使患者能够获得免费的戒烟服务，如戒烟热线。然而，战略规划是必要的，以成功地采用这种方法在整个卫生保健系统。本研究的目的是制定一个大型卫生系统中电子转诊到戒烟热线的实施策略。临床决策支持工具在电子健康记录系统和戒烟热线之间建立了一个闭环电子转诊途径。制定了多层次战略，在整个卫生系统实施电子转诊流程，包括领导层的支持、史诗提示单、通讯、实践冠军和工作人员的培训、医生教育者、以患者为中心的广告以及马里兰州卫生部烟草预防和控制中心分发的视频剪辑。全系统戒烟电子转诊途径的实施涉及持续的临床医生教育和培训，系统的质量控制，并聘请“冠军”临床医生。实施后的数据分析显示，在2018-2019年期间，Quitline共收到1，790个电子转介，其中18%接受了后续服务，18%拒绝了，64%在多次尝试后仍然无法达到。在接受戒烟热线服务的322名患者中，55%的人要求尼古丁替代治疗。总的来说，282名临床医生介绍了患者，包括107名初级保健医生和175名专家; 62名临床医生通过电子方式介绍了72%的患者，从而成为“烟草冠军”。“电子转介过程是烟草使用者从临床医生那里获得戒烟转介的有效方法。可持续性可以通过领导层的支持、医生的易用性、患者的积极性、信息技术支持和提醒来实现。
Electronic referrals provide an efficient solution for clinicians to connect patients to free tobacco cessation services, such as the tobacco Quitline. However, strategic planning is necessary for the successful adoption of this method across the health care system. The purpose of this study was to develop an implementation strategy for electronic referrals to the tobacco Quitline in a large health system. A clinical decision support tool created a closed-loop e-referral pathway between the electronic health record system and the Quitline. Multilevel strategies were developed to implement the e-referral process across the entire health system, including leadership buy-in, Epic tip sheets, newsletters, training for practice champions and staff, physician educator, patient-focused advertisements, and video clips distribution by the Maryland Department of Health Center for Tobacco Prevention and Control. The implementation of a system-wide e-referral pathway for tobacco cessation involved continuous clinician education and training, systematic quality control, and engaging "champion" clinicians. Postimplementation data analysis revealed that 1,790 e-referrals were received by the Quitline in 2018-2019, of which 18% accepted follow-up services, 18% declined, and 64% were not reached after multiple attempts. Among 322 patients who accepted Quitline services, 55% requested nicotine replacement therapy. Overall, 282 clinicians referred patients, including 107 primary care physicians and 175 specialists; 62 clinicians e-referred 72% patients, thereby emerging as "tobacco champions." The e-referral process is an efficient method for tobacco users to receive a cessation referral from clinicians. Sustainability can be achieved through leadership buy-in, physician ease of use, patient motivation, information technology supports, and reminders.