This smoking cessation intervention works!

July 1, 2016

A new clinical decision support tool prompts clinicians to ask parents about secondhand smoke exposure, provides an electronic nicotine replacement therapy (NRT) prescription, and makes referrals for follow-up and further guidance.

A new clinical decision support tool prompts clinicians to ask parents about secondhand smoke exposure, provides an electronic nicotine replacement therapy (NRT) prescription, and makes referrals for follow-up and further guidance. A study found that the tool is easy to use and has a clinical impact.

Investigators conducted the study within the Children’s Hospital of Philadelphia Pediatric Research Consortium, which includes 31 practices in 2 states. The tool, which interfaces with the electronic health record (EHR), first prompts the clinician to ask the parent about smoking status and whether he or she wants to quit. An affirmative response triggers a link to an electronic NRT prescription (nicotine patch or gum) with dosing guidance. Finally, the tool prompts clinicians to refer parents to an adult tobacco treatment program and additional resources and to update the EHR.

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During a 3-month period, clinicians used the tool at about three-quarters of more than 3000 visits at which 165 parents expressed interest in quitting smoking and were offered treatment. Although clinician use of the tool varied substantially, more than 75% of clinicians used the tool at more than 60% of visits. Of 24 clinicians (18 pediatricians and 6 nurse practitioners) who used the tool, 17 completed a follow-up survey. Of these, 94% reported that they were satisfied with the tool and found it helpful.

Among the tool’s advantages, ease of use, a reminder to screen all parents about smoking, and access to an electronic NRT prescription were cited by respondents. Nearly 90% of parents interested in quitting who were surveyed reported being satisfied or very satisfied with their treatment (64% received an NRT prescription and 25% had filled and were using it), and 28% noted that they were motivated to be treated because quitting was framed around helping their child (Jenssen BP, et al. Pediatrics. 2016;137[5]:e20154185).

Commentary: We know that we should screen for smoke exposure in the home, offer counseling and referral to smoking cessation resources, and arrange for NRT, but, as several studies have shown, we don’t. During a short office encounter, we encounter obstacles all along the way. The tool described here is an example of how the EHR makes it easier to get done what we know needs to be done. It prompts the physician to screen for smoke exposure, presents information on smoking cessation, allows arrangements for a recruitment call from a smoking cessation counselor, and provides a prescription for nicotine replacement with dosing information included. By removing obstacles, this EHR application could improve health for both parents and children. —Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.