TY - JOUR
KW - Attitude of Health Personnel
KW - Attitude to Health
KW - Community Mental Health Services/methods
KW - Focus Groups/methods
KW - Health Promotion/methods
KW - Hotlines/organization & administration/utilization
KW - Humans
KW - New York
KW - Patient Education as Topic/methods
KW - Primary Health Care/methods/organization & administration
KW - Program Development/methods
KW - Referral and Consultation/organization & administration
KW - Self Care/methods
KW - Smoking Cessation/methods/psychology
KW - Smoking/prevention & control/psychology
KW - Telefacsimile/utilization
KW - United States
KW - Urban Population/statistics & numerical data
AU - J. Cantrell
AU - D. Shelley
A1 - 
AB - BACKGROUND: Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. METHODS: The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. RESULTS: Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. CONCLUSIONS: Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.
BT - BMC family practice
C5 - Financing & Sustainability; HIT & Telehealth; Healthcare Policy
CY - England
DO - 10.1186/1471-2296-10-81
JF - BMC family practice
N2 - BACKGROUND: Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. METHODS: The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. RESULTS: Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. CONCLUSIONS: Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.
PP - England
PY - 2009
SN - 1471-2296; 1471-2296
SP - 81
T1 - Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study
T2 - BMC family practice
TI - Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study
U1 - Financing & Sustainability; HIT & Telehealth; Healthcare Policy
U2 - 20017930
U3 - 10.1186/1471-2296-10-81
VL - 10
VO - 1471-2296; 1471-2296
Y1 - 2009
ER -