Smoking as a vital sign: prompts to ask and assess increase cessation counseling

• Published in: Journal of the American Board of Family Medicine Vol. 22; no. 6; pp. 625 - 632
• Main Authors: McCullough, Anna, Fisher, Michael, Goldstein, Adam O, Kramer, Kathryn D, Ripley-Moffitt, Carol
• Format: Journal Article
• Language: English
• Published: United States 01.11.2009
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Counseling - statistics & numerical data; Electronic Health Records; Female; Humans; Male; Middle Aged; Smoking - psychology; Smoking Cessation - statistics & numerical data; Young Adult
• ISSN: 1557-2625; 1558-7118
• DOI: 10.3122/jabfm.2009.06.080211

Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?" Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P<.001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P<.005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P=.41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P<.001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456). Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.