Research Activities, August 2010: Mental Health: Trauma associated with mental health disorders but not substance abuse in homeless men

Outcomes/Effectiveness Research
Challenges abundant for practices that use fax referrals to smoking cessation quitlines

Forty-nine States offer "quitlines" staffed with experts that aim to help smokers cease smoking and reduce the time medical office staff spend providing advice on kicking the habit. However, a new study finds that the fax referral method that links patients with quitlines can be burdensome for medical office staff and resisted by patients.

Donna Shelley, M.D., M.P.H., of New York University, and her colleague found that a faxable referral form for a quitline required extra steps for office staff. They had to locate the form, explain the quitline program, and fax the completed form, which providers considered too long. Generally, no specific staff member was given responsibility for completing the form, so this task was often overlooked during appointments. And when fax referrals were made, quitline counselors reached only 41 percent of the patients, falling short of the quitline's 53 percent average. Clinic staff were often unable to track patient progress after making a referral and found that progress reports from the quitline were not very useful. Finally, patients were not always receptive to receiving phone calls from strangers offering to counsel them on quitting smoking.

The authors offer several suggestions for improving the program, including simplifying the fax referral form or making it Web-based, to ease the data collection burden on clinic staff. Assigning responsibility for completing and faxing the form to specific staff members could make the referral process run smoother. Clinics may also benefit from receiving improved progress reports that summarize progress on referred patients in order to reduce the paperwork burden of multiple individual progress reports. Finally, educating the public and clinic staff on the services the quitline provides may reduce the time clinic staff spend explaining the program and improve its uptake among patients. This study was funded in part by the Agency for Healthcare Research and Quality (HS16000).

See "Implementing a fax referral program for quitline smoking cessation services in urban health centers: A qualitative study," by Jennifer Cantrell, M.P.A., and Dr. Shelley in the December 17, 2009, BMC Family Practice 10 (81), pp. 1-11.

Research Activities, August 2010: Mental Health: Trauma associated with mental health disorders but not substance abuse in homeless men