Computer-Assisted Guidance for Dental Office Tobacco-Cessation Counseling: A Randomized Controlled Trial

doi:10.1016/j.amepre.2012.10.023

American Journal of Preventive Medicine

Volume 44, Issue 3, March 2013, Pages 260-264

https://doi.org/10.1016/j.amepre.2012.10.023 Get rights and content

Background

Decreases in smoking prevalence from recent decades have slowed, and national goals to reduce tobacco use remain unmet. Healthcare providers, including those in physician and dental teams, have access to evidence-based guidelines to help patients quit smoking. Translation of those guidelines into practice, however, remains low. Approaches that involve screening for drug use, brief intervention, and referral to treatment (SBIRT) are a promising, practical solution.

Purpose

This study examined whether dentists and dental hygienists would assess interest in quitting, deliver a brief tobacco intervention, and refer to a tobacco quitline more frequently as reported by patients if given computer-assisted guidance in an electronic patient record versus a control group providing usual care.

Design

A blocked, group-randomized trial was conducted from November 2010 to April 2011. Randomization was conducted at the clinic level. Patients nested within clinics represented the lowest-level unit of observation.

Setting/participants

Participants were patients in HealthPartners dental clinics.

Intervention

Intervention clinics were given a computer-assisted tool that suggested scripts for patient discussions. Usual care clinics provided care without the tool.

Main outcome measures

Primary outcomes were post-appointment patient reports of the provider assessing interest in quitting, delivering a brief intervention, and referring them to a quitline.

Results

Patient telephone surveys (72% response rate) indicated that providers assessed interest in quitting (control 70% vs intervention 87%, p=0.0006); discussed specific strategies for quitting (control 26% vs intervention 47%, p=0.003); and referred the patient to a tobacco quitline (control 17% vs intervention 37%, p=0.007) more frequently with the support of a computer-assisted tool integrated into the electronic health record.

Conclusions

Clinical decision support embedded in electronic health records can effectively help providers deliver tobacco interventions. These results build on evidence in medical settings supporting this approach to improve provider-delivered tobacco cessation.

Trial registration

This study is registered at ClinicalTrials.gov NCT01584882.

Section snippets

Background

Tobacco use is the single most prevalent cause of preventable disease and premature death in the U.S.¹ Guidelines for assisting patients with tobacco cessation are readily available.2, 3 Still, healthcare providers are missing opportunities to address tobacco-use cessation as recommended.4, 5, 6 Medical providers cite limited time, lack of health behavior change expertise, and concern with failure as barriers.⁷ Similar concerns have been raised in the dental setting.⁸

Dental and medical

Design

A two-arm, group-randomized trial design tested the effectiveness of an electronic dental record (EDR)-based intervention on patient-reported actions of their dentist's and dental hygienist's tobacco-related actions during a recall dental visit. The study was approved by the HealthPartners IRB. The dental visit included an examination by the dentist and also preventive treatments and diagnostic procedures as appropriate. Recall visits were targeted for a smoking intervention because an update

Survey Response Rate

Follow-up calls were attempted to 809 patient-smokers (Appendix B, available online at www.ajpmonline.org). Phone surveys were completed with 579 patient-smokers for a 72% response rate. Patients reporting nonsmoking status in the survey (n=31) were removed for an analytic file of n=548 (263 in the intervention arm, 285 in UC). Among nonresponders (230), 196 were unreachable within the 3-day window, and 34 refused the survey.

Survey Responders and Nonresponders

There were no significant differences between survey responders and

Discussion

A clinical decision support tool embedded in an EDR was effective at improving evidence-based tobacco-cessation efforts in the dental setting for patients who smoke cigarettes. Results add to the body of knowledge supporting the use of clinical decision support tools within EHRs to increase provider delivery of tobacco cessation11, 12 interventions and referral to telephone counseling.¹⁶

Provider script use was correlated with the patient-reported delivery of tobacco-cessation messages. With

References (21)

A.K. Ferketich et al.
Are physicians asking about tobacco use and assisting with cessation?Results from the 20012004 national ambulatory medical care survey (NAMCS)
Prev Med
(2006)
V.P. Quinn et al.
Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs
Am J Prev Med
(2005)
How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General[Report]
(2010)
Surgeon General's treating tobacco use and dependence: quick reference guide for clinicians
(2009)
Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement
Ann Intern Med
(2009)
M.B. Conroy et al.
Measuring provider adherence to tobacco treatment guidelines: a comparison of electronic medical record review, patient survey, and provider survey
Nicotine Tob Res
(2005)
S.A. Schroeder
What to do with a patient who smokes
JAMA
(2005)
D.B. Rindal et al.
Clinical inertia in dentistry: a review of the phenomenon
J Contemp Dent Pract
(2008)
R.A. Clay
Substance Abuse and Mental Health Services Administration: screening, brief intervention, and referral to treatment: new populations, new effectiveness data
(2009)
R. Boyle et al.
Use of electronic health records to support smoking cessation
Cochrane Database Syst Rev
(2011)

There are more references available in the full text version of this article.

Cited by (34)

FINDINGS AND FUTURE DIRECTIONS FROM A SMOKING CESSATION TRIAL UTILIZING A CLINICAL DECISION SUPPORT TOOL
2022, Journal of Evidence-Based Dental Practice
Citation Excerpt :
The impact of the COVID epidemic on clinic operations where enhanced protocols created greater demands on provider time also needs to be considered. Based on the results of prior trials,23,28,29 more than CDS will be required if smoking cessation interventions are to be routinely delivered in dental practices. The observations of Everett Rogers,36 made as he studied over 5000 innovations, hold some answers to what an environment that expects and supports smoking cessation interventions in dental offices might look like.
Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice.
To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months.
Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months.
Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant.
Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.
2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures
2017, Journal of the American College of Cardiology
Citation Excerpt :
Nevertheless, the EHR has counterbalancing advantages. EHR prompts have been demonstrated to increase tobacco counseling and referral for treatment (49–51). Multiple studies have reported that bans on public smoking are associated with a decreased risk of SCD (36,45,52,53).
Cardiovascular disease documentation and counseling in electronic medical records
2016, Preventive Medicine
Citation Excerpt :
EMRs have been found to support systemic improvements in care processes that will improve the population's health status and produce a concomitant cost savings as more expensive treatments are avoided (Furukawa, 2011; Linder et al., 2007; Poissant et al., 2005; Romano and Stafford, 2011; Selck and Decker, 2015). In particular, effective EMR use will improve providers' intervention rates on the major risk factors that are the precursors to costly chronic illnesses (Bae et al., 2015; Boyle et al., 2011; Rindal et al., 2013; Tang et al., 2012). Obesity is one of the most prevalent and readily identified risk factors to several chronic diseases.
The purpose of this paper is to explore the relationship between clinical reminders generated by electronic medical record (EMR) systems and providers giving prevention counseling to patients at-risk for cardiovascular disease (CVD). Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS). Results indicate that the providers routinely using clinical reminders are significantly more likely to document height and weight data to determine risk and provide the recommended counseling to patients that merit the intervention. The findings are important for policymakers and managers that have been promoting the adoption of more sophisticated EMR decision support functionalities across the care delivery spectrum. In particular, the ability to intervene prior to negative health events is an important feature of the movement to improve care quality and reduce costs.
Screening, brief intervention, and referral to treatment in oral health settings: A scoping review
2024, Community Dentistry and Oral Epidemiology
De-Implementing Opioids for Dental Extractions (DIODE): a multi-clinic, cluster-randomized trial of clinical decision support strategies in dentistry
2023, Implementation Science
Current state of dental informatics in the field of health information systems: a scoping review
2022, BMC Oral Health

View all citing articles on Scopus

View full text

Brief reportComputer-Assisted Guidance for Dental Office Tobacco-Cessation Counseling: A Randomized Controlled Trial

Background

Purpose

Design

Setting/participants

Intervention

Main outcome measures

Results

Conclusions

Trial registration

Section snippets

Background

Design

Survey Response Rate

Survey Responders and Nonresponders

Discussion

Prev Med

Am J Prev Med

How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General[Report]

Surgeon General's treating tobacco use and dependence: quick reference guide for clinicians

Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement

Ann Intern Med

Measuring provider adherence to tobacco treatment guidelines: a comparison of electronic medical record review, patient survey, and provider survey

Nicotine Tob Res

What to do with a patient who smokes

JAMA

Clinical inertia in dentistry: a review of the phenomenon

J Contemp Dent Pract

Substance Abuse and Mental Health Services Administration: screening, brief intervention, and referral to treatment: new populations, new effectiveness data

Use of electronic health records to support smoking cessation

Cochrane Database Syst Rev

Brief report
Computer-Assisted Guidance for Dental Office Tobacco-Cessation Counseling: A Randomized Controlled Trial