title: Implementing point of care "e-referrals" in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies.
abstract: Integrating electronic referral systems into clinical practices may increase use of web-accessible tobacco interventions. We report on our feasibility evaluation of using theory-driven implementation science techniques to translate an e-referral system (ReferASmoker.org) into the workflow of 137 community-based medical and dental practices, including system use, patient registration, implementation costs, and lessons learned. After 6 months, 2,376 smokers were e-referred (medical, 1,625; dental, 751). Eighty-six percent of the medical practices [75/87, mean referral = 18.7 (SD = 17.9), range 0-105] and dental practices [43/50, mean referral = 15.0 (SD = 10.5), range 0-38] had e-referred. Of those smokers e-referred, 25.3 registered [mean smoker registration rate-medical 4.9 (SD = 7.6, range 0-59), dental 3.6 (SD = 3.0, range 0-10)]. Estimated mean implementation costs are medical practices, US$429.00 (SD = 85.3); and dental practices, US$238.75 (SD = 13.6). High performing practices reported specific strategies to integrate ReferASmoker.org; low performers reported lack of smokers and patient disinterest in the study. Thus, a majority of practices e-referred and 25.3 % of referred smokers registered demonstrating e-referral feasibility. However, further examination of the identified implementation barriers is important as of the estimated 90,000 to 140,000 smokers seen in the 87 medical practices in 6 months, only 1,625 were e-referred.
authors.affiliation: Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA 01655-0002 USA ; VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA USA.
authors.forename: Rajani S
authors.initials: RS
authors.lastname: Sadasivam
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hogan
authors.forename: Julie E
authors.initials: JE
authors.lastname: Volkman
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.forename: Heather L
authors.initials: HL
authors.lastname: Coley
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Williams
authors.forename: Kathryn
authors.initials: K
authors.lastname: Delaughter
authors.forename: Midge N
authors.initials: MN
authors.lastname: Ray
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Gilbert
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
keywords: Dental practice public health informatics; Family practice; General practice; Health services research; Online behavior change systems; Randomized controlled trial; Smoking cessation