title: Clinician perceptions of factors influencing referrals to a smoking cessation program.
abstract: BACKGROUND
  Referral of patients to smoking cessation telephone counseling (i.e., quitline) is an underutilized resource by primary care physicians. Previously, we conducted a randomized trial to determine the effectiveness of benchmarked feedback on clinician referrals to a quitline. Subsequently, we sought to understand the successful practices used by the high-referring clinicians, and the perceptions of the barriers of referring patients to a quitline among both high and non-referring clinicians in the trial.
  
  
  METHODS
  We conducted a qualitative sub-study with subjects from the randomized trial, comparing high- and non-referring clinicians. Structured interviews were conducted and two investigators employed a thematic analysis of the transcribed data. Themes and included categories were organized into a thematic framework to represent the main response sets.
  
  
  RESULTS
  As compared to non-referring clinicians, high-referring clinicians more often reported use of the quitline as a primary source of referral, an appreciation of the quitline as an additional resource, reduced barriers to use of the quitline referral process, and a greater personal motivation related to tobacco cessation. Time and competing demands were critical barriers to initiating smoking cessation treatment with patients for all clinicians. Clinicians reported that having one referral source, a referral coordinator, and reimbursement for tobacco counseling (as a billable code) would aid referral.
  
  
  CONCLUSIONS
  Further research is needed to test the effectiveness of new approaches in improving the connection of patients with smoking cessation resources.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00529256.
authors: Department of Family Medicine, Michigan State University, B101 Clinical Center, East Lansing MI 48824, USA. jodi.holtrop@hc.msu.edu
authors: Jodi Summers
authors: JS
authors: Holtrop
authors: Rebecca
authors: R
authors: Malouin
authors: David
authors: D
authors: Weismantel
authors: William C
authors: WC
authors: Wadland
mesh_terms: D001291:Attitude of Health Personnel; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016540:Smoking Cessation