Dental Practice Implementation of a Point of Care Electronic Referral System for Patients Who Smoke: A Dental PBRN Study

Background: Tobacco use is the leading preventable cause of death in the U.S. and has been called the number one behavioral health problem. Although 1 in every 5 Americans smoke cigarettes, approximately 70% report that they want to quit smoking. There are many public health self-management interventions for smoking cessation that have been found to be effective; however, they are substantially underutilized. As more than half of smokers see a dentist at least once per year, patient referrals at point of care to a self-managed smoking cessation intervention could greatly increase their use. Methods: We conducted a randomized controlled trial with community-based dental practices testing point-of care referrals of smokers to an interactive, tailored patient education website. Intervention practices referred patients via an electronic referral system (ReferASmoker) and control practices referred patients via a paper-based information prescription. Both control and intervention practices had access to the ReferASmoker website that has resources to assist with tobacco cessation services. The intervention practices, but not the control practices, received feedback about their number of patient referrals and the referral numbers of their peers. Results: One hundred and one community-based dental practices from 8 states referred close to 1,900 patients to a patient education website for the self-management of smoking cessation. Based on estimates by the dental practices, the majority of patients were between the ages of 19 and 64 years, 23% of patients seen in participating practices were African American and 61% of practices saw patients with private insurance. Control and intervention practices were similar at baseline on all characteristics assessed except control practices had a higher self-reported proportion of African American patients. Based on the project coordinator comments, the ReferASmoker website was easy to use and offered useful resources to assist with tobacco control services. Conclusions: Providers actively engaged in the program and were willing to refer patients to an online, tailored patient education website. Dental practices found the ReferASmoker tool useful and easy to implement into practice