Fax Referral
According to the US Public Health Service Clinical Guideline: Treating Tobacco Use and Dependence (click here 
for the full document), a successful quit attempt has two pieces: counseling and medication. And while 98 percent of smokers in Iowa agree or strongly agree with the statement "smoking is harmful to my health," most smokers do not know how to quit.
As a health care provider, you can get them starting down the path to quitting by referring your patients to Quitline Iowa. Quitline Iowa offers free coaching that uses evidence-based interventions and is delivered by full-time tobacco counselors. Quitline Iowa also offers two-weeks of nicotine patches, gum, or lozenges sent to the patient's home for free. So both pieces of an effective quit attempt are waiting for your patients on the other end of the phone.
So how do you get started? It's easier than you think!
Refer patients to Quitline Iowa.
You can tell your patients to call, but very few will actually pick up the phone and dial. But when you use the Quitline Iowa Fax Referral Form, the quitline will call them. Over half of patients who are referred to quitline via fax enroll in coaching.
A fax referral is as simple as having the patient fill out the patient information box on the form (here , or Spanish form here ). If you would like a confirmation fax when the client signs up for coaching, be sure to fill out the provider information section. If the client is pregnant or has another contraindication to nicotine replacement therapy, be sure to sign the form if you want the patient to receive nicotine patches, gum, or lozenges.
The fax number is on the upper right hand corner of the form!
Medicaid (Title XIX) Referrals
If your client has Medicaid and would like to access their tobacco cessation benefit, you will need to fill out a Prior Authorization form (Chantix™ PA here , NRT PA here ). The fax goes to Quitline Iowa. Once they have enrolled the client in coaching, they notify Iowa Medicaid Enterprise who then approves the medication.
For an in depth description, click on the Medicaid link on the left hand side. For information about CPT codes and reimbursement, see the Medicaid Informational Letter here .
Order Materials for your Office.
Quitline Iowa materials can be ordered and shipped to your office for free. Just visit the Iowa Substance Abuse Information Center website 
and select tobacco. You can order once per month.
Learn More about Cessation Medication
Twenty years ago there were no medications to help people quit. Now there are seven first line medications approved by the FDA! Here are a few resources for you to explore:
- The American Academy of Family Physicians
- Department of Health and Human Services (AHRQ)
- Rx For Change (free, but registration required)
Ask Us Anything!
If you want more information about Quitline Iowa or would like a speaker to talk to your organization about cessation interventions or other tobacco topics, drop us an email at through the Contact Us link in the top corner of your screen (be sure to select Quitline from the drop-down menu). Emails are generally returned in one business day.
Due to privacy issues, we cannot share patient data.
About our Evaluation Information
An independent evaluation published in 2009 demonstrated 12 months after the first time someone calls Quitline Iowa, there is a 21 percent chance they will be a non-smoker. Quitting cold turkey only works five percent of the time. And among the callers that did not quit, they smoked 25% fewer cigarettes, making their next quit attempt easier!
View the full report here (specifically, the purple charts on pages 17 and 18).
