Fax to Quit: Linking smokers visiting primary care clinics to state quitlines

Context: Fax referral programs can quickly and economically link smokers visiting primary care clinics to state-based quitlines. Yet, it is unclear how to optimize use of this promising strategy.

Objective: To evaluate the potential of enhanced academic detailing (i.e., on-site training, technical assistance and performance feedback) to boost utilization a fax referral program, Fax to Quit.

Design, Setting, & Participants: A randomized clinical trial in forty-nine primary care clinics in southern Wisconsin. After monitoring baseline quitline utilization, the clinics were randomized to two fax referral program interventions, Fax to Quit alone (F2Q-Only) or Fax to Quit plus Enhanced Academic Detailing (F2Q +EAD).

Main Outcome Measures: Clinic and clinician-specific referral rates and quality referrals (those that result in quitline enrollment) were measured for 13 months post-intervention.

Results: Fax-referrals to the Wisconsin Tobacco Quit Line increased substantially from baseline in both intervention groups. Mean post-intervention referral rate per clinician was 5.3 times greater for F2Q + EAD (7.0, SD=6.9) compared to F2Q-Only (1.5, SD=3.6, p<.001). In terms of quality referrals, 473 smokers from F2Q + EAD clinics versus 88 from F2Q-Only were successfully enrolled in quitline services (5.4 times as many).

Conclusion: Enhanced academic detailing, that included on-site training, technical assistance, and performance feedback, increased the number of referrals per clinician more than five-fold over a basic fax referral program. F2Q + EAD offers clinicians and health systems a promising route to enroll their patients into evidence-based tobacco cessation treatment.