Chan, Kayshin, MPH

Dalla-Palu, Alice, MPA, CTTS-M, CAC

Fignar, Jeanne, AAS

Lavan, Patricia, RDH, BA

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Emergency MedicineQuitline Fax Referrals – Increasing Enrollment andOutcomesAlice Dalla-Palu MPA, CTTS-M, CACLehigh Valley Health Network, Alice.DallaPalu@lvhn.orgJeanne Fignar AASLehigh Valley Health Network, Jeanne.Fignar@lvhn.orgPatricia Lavan RDH, BARural Health Corporation of Northeastern PAKayshin Chan MPHPublic Health Management CorporationFollow this and additional works at: http://scholarlyworks.lvhn.org/emergency-medicinePart of the Emergency Medicine Commons, Public Health Commons, Statistics and ProbabilityCommons, and the Substance Abuse and Addiction CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtDalla-Palu, A., Fignar, J., Lavan, P., & Chan, K. (2012). Quitline fax referrals - increasing enrollment and outcomes.1Tobacco Free Northeast PA and Lehigh Valley Health Network, Allentown, PA; 2Rural Health Corporation of Northeastern PA, Wilkes-Barre, PA; 3Public Health Management Corporation, Philadelphia, PAQuitline Fax Referrals – Increasing Enrollment and OutcomesAlice Dalla Palu, MPA, CTTS-M, CAADC1; Jeanne Fignar, AAS1, Patricia Lavan, RDH, BA2; Kayshin Chan, MPH3PA Quitline vendor change in July 2011BackgroundAnalysis of Quitline data: Monthly quantitative data from the Quitline were analyzed to determine the number of fax referrals, percent of enrollees, and enrollee outcomes. Pilot participants were coded so they could be easily identified in the tracking system. These outcome data were reviewed monthly as part of the pilot’s process evaluation.Key informant interviews: PHMC conducted interviews with TFNE staff and Pilot healthcare staff to gather feedback on using the fax referral system. PHMC also interviewed other healthcare providers who did not use fax referral to understand their perspectives about using fax referral in the future. These non-pilot providers were selected with input from three health district regions. A total of 6 district staff, 10 pilot providers, and 7 non-pilot providers were interviewed between June and August 2011. While some questions were tailored for their role in the project, all participants were asked for feedback on the fax referral system and the most effective ways to roll out the system across the state. Alternately, TFNE staff interviewed Pilot site provider staff after training and during the first few months of the Pilot to ascertain their level of knowledge and document their feedback or questions. All providers offered positive feedback and several took time to say how grateful they are to have this opportunity for their patients.The Pennsylvania Free Quitline has a fax referral system, but the system has not been used to its full potential. During 2011, the Pennsylvania Department of Health, Division of Tobacco Prevention and Control (DTPC) implemented a fax referral pilot initiative with the primary goal of increasing the number of successful fax referrals to the PA Free Quitline from health care providers on behalf of their patients. The fax referral pilot was designed to reach disparately impacted populations, focusing on low income and rural smokers. This initiative aimed to increase awareness of the fax referral process and test a feedback system among select health care providers.In the Northeast Health District, Rural Health Corporation agreed to participate in the fax referral pilot coordinated by Tobacco Free Northeast PA (TFNE). Rural Health is uniquely positioned to offer this option for their patients as they are a multi-site (10) outpatient health system in two of the highest smoking prevalence counties in Pennsylvania. Their sites are located in urban and rural settings with a diverse demographic patient base. The sites include a homeless shelter, pediatric clinic, dental and medical clinics.There were three key features of the Pilot fax referral:1	 	Healthcare	providers	involved	with	the	pilot	received	tailored	trainings	on	brief	intervention	based	on	the	Clinical	Practices	Guideline,	(US	Department	of	Health	and	Human	Services,	2008),	and	training	on	fax	referral	optimization.2	 	Patients	who	enrolled	in	the	Quitline	fax	referral	received	a	free	30	day	NRT	kit.3	 	Healthcare	providers	who	used	the	fax	referral	system	received	outcome	feedback	on	each	patient.•	 	#	Fax	Referrals	to	Quitline•	 	#	Referrals	pending•	 	#	Clients	accepted	treatment•	 	#	Clients	declined	treatment•	 	#	Clients	unable	to	contactFax Referral Pilot EvaluationDTPC was interested in gathering feedback about pilot sites’ experiences and opinions from participating and non-participating healthcare sites about using a fax referral system. As part of the statewide evaluation, the Research and Evaluation Group at Public Health Management Corporation (PHMC) evaluated the fax referral Pilot so that the findings from the evaluation can inform the expansion of the fax referral system across the Commonwealth.There were four main evaluation questions for the pilot initiative:1	 	Are	pilot	sites	able	to	use	Quitline	fax	referral	to	assist	at	least	100	tobacco	users	over	a	three	month	period?2	 	What	trends,	if	any,	are	seen	in	fax	referral	enrollee	characteristics?	Are	fax	referral	enrollees	similar	in	demographic	characteristics	and	tobacco	use	patterns	to	other	Quitline	callers?	What	do	similarities/differences	tell	us	about	the	potential	reach	of	fax	referral?3	 	How	do	the	regional	fax	referral	implementation	models	affect	referral	and	outcomes?4	 	What	are	the	barriers	and	supports	for	health	care	providers	in	using	a	fax	referral	system?MethodsThe following quantitative and qualitative methods were used to answer the four key evaluation questions.Preparation: TFNE has a long standing relationship with Rural Health both with training their providers and having a sub contractual arrangement to provide cessation counseling in their two counties of Luzerne and Wyoming. Rural Health’s fax referral coordinator created logs and other documents to track the referrals for the pilot and reported back to TFNE, who reported these program outcomes to PHMC and DTPC monthly. If there were issues between reports, communications were exchanged to resolve them.Training: All 10 Rural Health sites were trained in March 2011 by a regional trainer, using the presentation “Every Smoker, Every Time: Brief Clinical Interventions for Successful Smoking Cessation.” For many providers, this was not their first training in brief intervention and cessation referral, so the training served more as a refresher course. Trainees did receive specific training on the fax referral Pilot.Implementation: Rural Health coordinator keyed a coded site-specific fax referral form from the Rural Health intranet system for site download. Patient faxes were sent from the clinic site to the fax referral coordinator, who logged each referral, and then forwarded faxes to the Quitline to initiate a proactive call. If the patient preferred local/face-to-face tobacco treatment, the coordinator initiated contact with patients to offer counseling. All communication between the pilot providers/sites and the Quitline was managed through the fax referral coordinator. She also notified referring providers about the outcomes of their fax referrals as the Quitline shared follow up information.Pilot ModelMonitoring: The fax referral coordinator worked closely with the pilot providers to ensure that the system ran smoothly. She attends RHC’s regular medical and dental staff meetings, so the providers received constant reminders about using the fax referral system. When she discovered that there was a mix-up over feedback forms, she contacted DTPC and resolved the issue. She prepared monthly status reports which included the following information: •	 	#	Clients	referred	to	face	to	face	counselor•	 #	Clients	enrolled•	 	#	Clients	declinedResultsHaving a parent health system with multiple sites and a fax referral coordinator was an effective way to engage providers in using the fax referral system and resulted in more fax referrals. The six month Pilot facilitated 486 referrals compared to 83 referrals from the same time period the prior year; an almost 6-fold increase in referrals that include provider brief interventions. The Pilot resulted in 154 participants in treatment.  Those referred that did not go on to participate in treatment may still experience a positive change in readiness to quit, as research has shown the multiple interventions move patients through the stages of behavior change. RecommendationsBased on the key informant interviews, there were several lessons learned and recommendations for future dissemination of the fax referral system.1	 	An	ideal	model	for	implementing	a	fax	referral	system	is	to	have	a		fax referral coordinator in one central health system manage	incoming	and	outgoing	fax	referral	reports	for	all	sites.	The	fax	referral	coordinator	serves	as	the	contact	person	between	the	different	medical	sites,	the	district	primary	contractor,	and	Quitline	vendor.	The	coordinator	can	continuously	check	in	with	providers	to	remind	them	to	use	the	system	and	troubleshoot	any	problems.	It	is	also	important	to	identify	a	key	staff	person	at	the	Quitline	vendor	to	deal	with	any	issues.2	 	If	a	sites’	coordinator	is	not	possible,	it	would	be	important	to	designate	a	regional point of contact	to	coordinate	the	training	and	serve	as	a	fax	referral	contact	person.	When	possible,	use	in-person, brief training at providers’ offices	to	describe	the	fax	referral	system.3	 	Selecting	sites	to	participate	in	fax	referral	is	most	efficient	when	there	are	established relationships	with	the	site.	Fax	referral	is	likely	straightforward	for	health	systems	which	already	have	cessation	referral	protocols	in	place,	but	when	working	with	sites	not	accustomed	to	screening	for	tobacco,	plan	for	additional	staff	and	administrative	training	and	troubleshooting.4	 	Key factors	to	getting	healthcare	providers	involved	with	fax	referral	include:   a 	Information	about	Quitline	as	an	effective	service;   b 	Free	NRT	kits	for	patients	who	enroll	through	fax	referral;   c 	Timely	feedback	reports	about	patient	enrollment	status.5	 	All	fax	referral	efforts	and	trainings	should	include	a	description	of		how the Quitline fax referral system complements the availability of local cessation services.	Providers	should	understand	that	face-to-face	and	telephone-based	cessation	treatment	options	are	not	in	competition,	rather	they	support	one	another.6	 Explore	the	possibility	of	electronic referral	to	engage	larger	health	systems.*  Tobacco Free Northeast PA at Burn Prevention Network is funded by a grant from the Pennsylvania Department of Health Tobacco Prevention and Control Program to provide tobacco services in the Northeast Health District. Our Mission is to improve the quality of life in our communities by reducing tobacco use -- serving the counties of Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Susquehanna, Wayne and Wyoming.RURAL HEALTH CORPORATIONOF NORTHEASTERN PA4736134352050100150200250300350400A pril-June2010Ju ly-S ep t.2010A pril-June2011Ju ly-S ep t2011Referrals to Quitline 2010-201140217050100150200250U nable to C on tact - 2011A pril-JuneU nable to C on tact - 2011Ju ly-S ep t.Unable to Contact0 080740102030405060708090Q uitline In T rea tm ent 2011A pril-JuneQ uitline In T rea tm ent 2011Ju ly-S ept.In Treatment0 014370510152025303540D ec lined Treatm ent A pril-June D ec lined Treatm ent Ju ly-S ept.Refused TreatmentFigure 1:  R ferrals to Quitline 2010-2011 Figure 2:  Unable to ContactFigure 3:  In Treatment Figure 4:  Refused Treatment

Quitline Fax Referrals – Increasing Enrollment and Outcomes

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1210&context=emergency-medicine

Quitline Fax Referrals – Increasing Enrollment and Outcomes

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