Baylor Scott & White Health, the University of Texas at Austin and the Texas Department of State Health Services are training physicians to use eTobacco, a smoking and tobacco-cessation initiative that connects a patient’s electronic medical records (EMR) with a state-funded program called Quitline.
There is a Quitline in every U.S. state, funded by the legal settlement between the four largest U.S. tobacco companies and state attorneys general in 1998. Quitlines have been effective, but only 1 percent of U.S. smokers have used them, and only 17 percent of those said their health care provider referred them.
Participating providers must ask all patients whether they use tobacco and, if so, whether they would like to quit. With eTobacco, the doctor can use the patient’s EMR to make a digital referral to Quitline. Eligible patients are contacted within 48 hours, counseled and provided free nicotine replacement therapy. Enrollees can receive five counseling sessions by telephone and unlimited access to the website yesquit.org. When the patients’ program ends, prescribing physicians receive feedback on patients’ progress through the EMR.
About 70 percent of smokers visit a primary care clinic annually, and a majority of them would like to quit. Clinicians have access to many effective evidence-based treatments to help smokers quit, but too few patients are referred to those programs.
Electronic referral to the program was pilot tested in three Austin clinics in 2011. Before it was used, those clinics referred only seven patients to Quitline by fax. Once they began using the electronic referral method, referrals soared to 1,254. An experiment in 10 Kelsey Seybold Clinic locations in Houston found that electronic referral in 2011 boosts participation 13-fold. A similar test in Wisconsin boosted smoker referrals from 0.3 percent to 14 percent –a 46-fold increase.
“This initiative will have a huge impact on the No. 1 preventable risk factor for all chronic diseases — tobacco use — and stands to net the state over $271 million in health care cost reductions and workforce productivity increases,” says Michael Davis, project lead and director of the Cancer Institute at Baylor Scott & White Health. Davis’s estimate reflects eventual implementation across Central and North Texas, when the program will be available to all Baylor Scott & White Health patients.
A 2006 Texas study by the Center for Health Research at Kaiser Permanente found that for every Texan who quits smoking, there is a five-year savings of $8,127 in medical costs and lost productivity. Davis said BSWH realistically could get 35,000 patients to quit in the first year, which would lead to the $271 million savings. Davis said a patient who is referred to a smoking cessation program by a health care provider is 60 percent more likely to succeed, compared with those who attempt to quit on their own.
Davis said the system’s Central Texas division sees over 400,000 unique-adult patients annually while the North Texas division treats nearly twice that many. He said eTobacco would expand to North Texas beginning in July, vastly magnifying the population health impact of the initiative.
- Smoking kills an estimated 24,500 Texans annually. (Tweet this)
- Costs include $12.2 billion in excess medical care expenditures and lost productivity annually in Texas. (Tweet this)
- Annual medical care costs related to smoking are more than $5.8 billion. (Tweet this)
- Tobacco use remains the leading cause of premature and preventable death in the U.S. (Tweet this)
- Lung cancer is the No. 1 cancer-related cause of death among both men and women. (Tweet this)