March/April - West Virginia State Medical Association

Scientific Article |
tobacco treatment is needed among
pregnant smokers in West Virginia. 18
Findings from this pilot indicate
that Fax-to-Quit is a feasible option
to engage providers and pregnant
smokers with the West Virginia
Tobacco Quitline. Successful referrals
and enrollment among pregnant
WV smokers indicate that Fax-to-
Quit may support quit attempts
by increasing Quitline usage and
connecting these women with
cessation services through provider
faxed referrals to the Quitline.
We acknowledge that our current
protocol would be changed in
future implementation efforts to
capture advances in technology.
For example, we would consider
conducting the next phase of our
Fax-to-Quit Program with hand-held
portable devices, such as an iPad
or iPod, to electronically submit
the referral and offer compatibility
with electronic medical record
systems at provider offices.
Our study was limited by small
sample sizes related to both referrals
and program enrollment. Fifteen
women enrolled (out of 58 referrals),
and only slightly more than half of
those enrolled completed the post
survey 6-month follow-up. While
we realize that these small numbers
and loss to follow-up limit the
generalizability of study results,
we emphasize the feasibility of the
process based upon our findings.
The additional challenges of working
with clinic sites were educational for
our implementation team, in terms
of: logistical process and feasibility
related to organization; time
allocation of physicians and office
staff; and relocation, with one site
moving out of West Virginia during
the study period. We also recognize
the valuable lessons learned in terms
of communication and organization
at the clinic sites, which will be
incorporated into future clinicbased
smoking cessation studies
among smokers in West Virginia.
Fax-to-Quit programs and
referring participants to a Quitline
have been successfully used in other
states, such as Oregon, Michigan,
and most notably Wisconsin. 11,19-21
The Fax-to-Quit program is
straightforward, and is based upon
the principles of the 5 A’s (Ask,
Advise, Assess, Assist, Arrange)
as developed by the US Public
Health Service/AHRQ clinical
guidelines for treating tobacco use
and dependence. 12 A recent study
by Okoli and colleagues (2010)
reported that greater than 50% of
health care providers will be likely
to ask women about their smoking
status in a primary care visit and
advise pregnant smokers to quit;
however, fewer than half will either
assess readiness to change, assist
in smoking cessation, or arrange
for follow-up appointments/
referrals. Provider, patient, and
system/organizational barriers
were all identified that can hinder
the provision of smoking cessation
services by health care providers. 22
West Virginia’s high unmet
need for smoking cessation among
pregnant women is compounded
by issues of health disparities, low
socioeconomic status (low SES), low
rates of higher education, and rural
access to care. Programs such as
Fax-to-Quit can offer opportunities to
address barriers at provider, patient,
and organizational levels, increasing
effective communication and
providing services to address unmet
needs for cessation among West
Virginia’s pregnant women who
smoke. The increase in calls from
pregnant smokers to the WV Quitline
in the past 12 months is an important
accomplishment and emphasizes the
feasibility of programs to encourage
awareness and offer opportunities for
pregnant women smokers to contact
the Quitline. Fax-to-Quit may begin
to bridge the cessation gap among
underserved pregnant women who
smoke in this rural West Virginia
population. Further exploration of
additional programs and means
to motivate women to contact the
West Virginia Quitline is needed
to promote its use as a statewide
accessible cessation resource.
Acknowledgements
The authors would like to
acknowledge the United States
Department of Health and Human
Services, Centers for Disease Control
and Prevention, for providing
funding for this feasibility pilot in
award number: U36 CCU319276.
References
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20 West Virginia Medical Journal