Quitline program utilization and cessation outcomes: A comparison of provider-referred clients by healthcare settings

Abstract

US Public Health Service guidelines recommend that healthcare providers assess patients for tobacco use and refer tobacco users to cessation services (e.g., quitlines). However, once referred, little is known on how program outcomes for referred tobacco users vary across healthcare settings. To examine differences in program enrollment, dropout at follow-up, utilization (number of coaching sessions and nicotine replacement therapy use), and quit outcomes among tobacco users referred across settings to a state quitline. In a retrospective analysis of clients referred to the quitline (January 2011–June 2016), referrals were categorized into six settings: general medical practice (reference group), acute care hospitals, behavioral health, federally qualified health centers (FQHCs), county health departments, and specialty clinics. Outcome variables included enrollment, dropout, program utilization, and 30-day tobacco abstinence at 7-month follow-up. Compared to medical practices, clients referred from behavioral health were less likely to enroll in services (OR = 0.81, 95%CI: 0.76, 0.87), less likely to report using NRT in-program (OR = 0.51, 95%CI: 0.42, 0.62), and along with clients referred from FQHCs (OR = 0.78, 95%CI: 0.64, 0.94) were less likely to be quit at follow-up (OR = 0.73, 95%CI: 0.59, 0.92). Clients referred from acute care hospitals were less likely to enroll in services (OR = 0.60, 95%CI: 0.56, 0.64) and were more likely to drop-out of cessation services (OR = 1.12; 95%CI: 1.00–1.26). Findings reflect the need for better tailoring of messages for tobacco assessment within specific healthcare settings while bolstering behavioral counseling that quitlines provide to increase enrollment, engagement, and retention in tobacco cessation services.

Highlights

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  Public health guidelines recommend providers across healthcare settings refer tobacco users to evidence-based services.

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  Little is known how clients referred across healthcare settings vary in program engagement and retention and quit outcomes.

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  Study results show variability in enrollment, program utilization, and quit outcomes for clients referred across settings.

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  Findings reiterate the need for tailored messaging given to tobacco users at the provider level.

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  Tailored and multi-modal strategies by quitlines may help increase client enrollment and engagement in services.