Summary: | Background and challenges to implementation
We know that
providers are more willing to refer patients if an automatic referral is
imbedded into the Electronic Medical Record (EHR). Extensive education to
improve knowledge for healthcare providers to refer tobacco using patients to
cessation services will help the patient better understand the services in
which they are being referred and could improve overall acceptance rates.
Intervention or response
The intervention included monthly
referral numbers from Quitline data for a 29 month period from January
2015 to May 2017. Our research questions included an increasing trend
of number of referral by EHR, and whether EHR is a significant factor for the
rate of acceptance by comparing this to paper-based fax referrals to the same
service. Two analysis were conducted to answer the research questions: 1)
a time series analysis looking at the trend of number of referral by EHR; 2) A
MANOVA testing whether EHR is a significant factor for number of referrals and
rate of acceptance.
Results and lessons learnt
The average acceptance rates were 7.0% for EHR
referrals and 4.2% for fax referrals. Based on time-series models, there was a
seasonally increasing trend of referral by EHR (B=.13, R2=.62). Both
the average numbers of Quitline referrals and the rate
of acceptance were statistically significantly different between EHR
and fax referral (p < .001). Although
compared to paper-based referrals, number of Quitline referrals by EHR was
lower, the acceptance rates was higher if referred by EHR.
Conclusions and key recommendations
Integrating an
electronic referral for cessation services provides favorable results in provider
adherence to referring patients to services and the patients' willingness to
accepting services to quit tobacco. The key finding and recommendation is to
continue to work in the field of integrating a systematic approach to referring
patients to cessation services through the EHR. Patient acceptance of services
significantly improved with a systematic approach in place.
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