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  • Title: Smoking as a vital sign: prompts to ask and assess increase cessation counseling.
    Author: McCullough A, Fisher M, Goldstein AO, Kramer KD, Ripley-Moffitt C.
    Journal: J Am Board Fam Med; 2009; 22(6):625-32. PubMed ID: 19897690.
    Abstract:
    BACKGROUND: 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?" METHODS: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. RESULTS: 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). CONCLUSIONS: 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.
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