Table 3 Themes related to clinical information systems and patient self-management

Clinical information systems

Need for internal tracking systems and staff to follow up with smokers

"How do we follow up - let's say the patient came in and he did this [the fax referral] with me. How do I know that they actually called you? That they actually did something? How am I going to remember the patient?" (Medical Assistant)

"It would make sense to have a nurse in charge of picking up progress reports [from the Quitline] when they come in, and following up with patients. We just don't have the staff resources." (Physician)

Limited understanding of specifics of the Fax-to-Quit program

"There's a sheet that comes back, usually informing us they [patients] have not been contacted but in terms of knowing how things are actually working, I'm not so sure about that." (Nurse)

Need for improved external information from Quitline

"I'm all about seeing the big picture so if they [the Quitline] could give you a printout of all the people referred, it can give us a sense of scale. That would help with sustainability." (Physician)

"If I got a summary sheet of the patients, and these were unable to contact, and how many we actually did contact, and if there was any set plan, or patients were sent patches. It'd be nice to see a summary of the 25 people that you referred." (Physician)

"Beyond the quantitative, it might be nice to hear some qualitative feedback. Perhaps a case scenario where a real connection happened - an example of an optimal Fax-to-Quit patient interaction." (Physician)

Patient self-management

Fax-to-Quit as a valuable resource for patients to manage their smoking

"I think there's value in it. I love the fact that someone did a follow up. A behavior modification with reinforcement might make a more effective process." (Physician)

Patients were skeptical of the Fax-to-Quit program

"I've asked them, 'Do you want to fill this document out?' But all the questions come up, and that's where it starts. They ask you over and over so you have to give them some time." (Medical Assistant)

"There are definitely a lot of resistant people at the idea of somebody calling them. They're like 'No, no, no."' (Physician)

Need for patient education

"You would get a lot more response if you had one person in the front [waiting room], you might get this [Fax-to-Quit form] filled out. It's a lot simpler than us having to rush through it." (Medical Assistant)

"The waiting period for the patients after they see us, the MAs, to see the doctor, it could be lengthy. And it could be used to educate the patient." (Medical Assistant)