Implementing a Staff‐Led Smoking Cessation Intervention in a Diverse Safety‐Net Rheumatology Clinic: A Pre‐Post Scalability Study in a Low‐Resource Setting

Abstract

ObjectiveQuit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26‐fold in a predominantly White academic health care system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety‐net rheumatology clinic with a predominantly Black population.MethodsIn this pre‐post study, adult rheumatology visits were analyzed 12 months before through 18 months after QC intervention (November 2019 through November 2021, omitting COVID‐19 peak April through November 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre‐post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost‐effectiveness was also assessed.ResultsVisit‐level patients who smoked were 89.8% Black and 69.5% women (n = 550). Before intervention, clinic staff rarely asked patients about readiness to cut back smoking (<10% assessment). After QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% before); 58.9% of these patients endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4 to $10.ConclusionIn a safety‐net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness‐to‐quit assessment, and referrals and was also feasible and cost‐effective.image