Smoking-cessation e-referrals: a national dental practice-based research network randomized controlled trial.
BACKGROUND
Tobacco use is still the leading preventable cause of death and morbidity in the U.S. Web-assisted tobacco interventions are an effective but underutilized tool in assisting smokers with quitting. The dental visit is an excellent opportunity to assist smokers in quitting by referring them to these tobacco-cessation online programs.


OBJECTIVE
The study purpose was to test two patient referral methods-paper referrals (information prescriptions) versus paper plus e-referrals-to a web-assisted smoking-cessation induction system.


METHODS
RCT that used implementation research methods.


METHODS
A total of 100 community-based dental practices were enrolled and 1814 smokers were referred to the web-assisted tobacco induction system.


METHODS
The study intervention was a proactive e-referral of smokers to a web-assisted tobacco induction system called Decide2Quit.org, and the control group used paper referrals (information prescriptions) to refer smokers to the Decide2Quit.org.


METHODS
The outcome measurements were the referral numbers, Decide2Quit registration numbers, and the smokers' quit rate. Data were collected in 2010-2011 and analyses were completed in 2012.


RESULTS
Although total referrals from intervention practices was lower than control, subsequent proportions of registrations among smokers referred to Decide2Quit.org were nearly fourfold higher (adjusted mean percentages: 29.5% vs 7.6%, p<0.01) in intervention compared with control practices. Subsequent rates of cessation among referred smokers were threefold higher (adjusted mean percentages: 3.0% vs 0.8%, p=0.03) in intervention practices as compared with control.


CONCLUSIONS
Intervention practices using the e-referral system had higher smoker registration numbers and higher quit smoking rates than the control practices. This study finds that e-referrals are effective in getting smokers to the web-assisted smoking-cessation induction system and in assisting with quitting that more than compensates for any additional effort that e-referrals require on the part of the practitioner.


BACKGROUND
DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation (HiQuit); NCT01108432.
Department of Health Services Administration (Ray, Williams), School of Health Professions. Electronic address: midgeray@uab.edu.
Midge N
MN
Ray
Division of Preventive Medicine (Funkhouser).
Ellen
E
Funkhouser
Department of Health Services Administration (Ray, Williams), School of Health Professions.
Jessica H
JH
Williams
Division of Health Informatics and Implementation Science (Sadasivam, Houston), Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester.
Rajani S
RS
Sadasivam
Department of Clinical and Community Sciences (Gilbert), School of Dentistry.
Gregg H
GH
Gilbert
Division of Infectious Disease (Coley), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Heather L
HL
Coley
HealthPartners Institute for Education and Research (Rindal), Minneapolis, Minnesota.
D Brad
DB
Rindal
Division of Health Informatics and Implementation Science (Sadasivam, Houston), Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester; eHealth Quality Enhancement Research Initiative (Sadasivam, Houston), Bedford VAMC, Bedford, Massachusetts.
Thomas K
TK
Houston
D000328:Adult; D000368:Aged; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019239:Practice Patterns, Dentists'; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data