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Health care provider reminder systems for tobacco cessation

Health Factors: Tobacco Use
Decision Makers: Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 10-19% of WI's population
Impact on Disparities: Likely to increase disparities

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Description

Provider reminder systems remind or encourage health professionals to support tobacco cessation among their patients. Such systems can include provider trainings, organizational protocols or referral processes, financial remuneration for providers, and materials such as self-help pamphlets and pharmacotherapy (Rosseel 2012).

Expected Beneficial Outcomes

Increased quit rates
Reduced youth smoking
Increased access to cessation treatment

Evidence of Effectiveness

There is strong evidence that provider reminder systems for tobacco cessation improve quit rates (Abrams 2010). Reminders and training encourage health care providers to conduct brief tobacco interventions (Freund 2009, Pbert 2006), which then help patients quit smoking (Abrams 2010). Dental office (Cochrane-Carr 2012, Gordon 2006, Dent 2007), physician (Cochrane-Stead 2013), and nurse-led (Cochrane-Rice 2013) interventions have all been shown to help smokers quit smoking. In some circumstances, interventions may persuade youth not to start (Patnode 2013, Gordon 2006).

Dental office interventions improve quit rates (Gordon 2006, Dent 2007) for both smokers and smokeless tobacco users (Cochrane-Carr 2012). Including feedback on patients’ salivary nicotine levels and NRT provision may yield especially strong effects. Systems to prompt intervention increase documentation of smoking status and advice regarding cessation, and appear to improve quit rates. Researchers suggest involving the entire dental team, integrating structured protocols into the care routine, and combining provider education with ongoing support so that providers will support patient cessation (Rosseel 2012). 

Both brief (Aveyard 2012) and more intensive physician interventions improve quit rates. Longer consultations or more follow-ups can yield somewhat stronger effects than minimal advice (Cochrane-Stead 2013). Advice provided with NRT appears more effective than advice alone (Aveyard 2012). Providing NRT without screening for willingness to quit may also increase quit rates by increasing the likelihood of a quit attempt and modestly increasing the success of those attempts (Aveyard 2012).

Nurse advice or counseling improves quit rates (Cochrane-Rice 2013). More intense interventions or interventions conducted by a health promotion or smoking cessation-focused nurse may yield stronger effects than brief interventions or those conducted by nurses with other primary roles (Cochrane-Rice 2013).

The US Department of Health and Human Services recommends providers use the 5 As (Ask, Advise, Assess, Assist, and Arrange) to identify smokers ready to quit, equip them with quitting tools, and arrange follow-up treatment (US DHHS-Treating tobacco use). Many systems lead providers to ask about smoking, but not to connect patients with quitting resources (Freund 2009, Boyle 2010) or arrange follow-up (Cochrane-Lancaster 2000). Electronic health record system prompts (Cochrane-Boyle 2011) or financial incentives for physicians or clinics can increase documentation of tobacco status and referrals to cessation counseling (Hamilton 2013). However, additional evidence is to determine the effects of financial incentives on quit rates (Hamilton 2013).

Some studies indicate that white patients are more likely to be screened and counseled than minority patients (Sonnenfeld 2009, Cokkinides 2008). Provider reminder systems appear to be more cost-effective than other tobacco reduction interventions (Feenstra 2005).

Implementation

United States

CDC Survey data indicates that about 69% of smokers want to quit. Physicians are more likely to advise quitting than to discuss cessation strategies or medications (NCQA 2013).

Implementation Resources

AHRQ-Tobacco pathfinder - Agency for Healthcare Research and Quality (AHRQ). Treating tobacco use and dependence pathfinder: 2008 update. Accessed on November 27, 2015
Help Teens Quit - Help Teens Quit. Tools & handouts: Clinical tools. Accessed on February 24, 2016
PFP-Provider reminder systems - Partnership for Prevention (PFP). Healthcare provider reminder systems, provider education, and patient education: Working with healthcare delivery systems to improve the delivery of tobacco-use treatment to patients - An action guide. Washington, DC: Partnership for Prevention; 2008. Accessed on December 22, 2015
Rx for change - University of California San Francisco. Rx for change: Clinician-assisted tobacco cessation. Accessed on March 2, 2016

Citations - Description

Rosseel 2012* - Rosseel J, Jacobs J, Plasschaert A, Grol R. A review of strategies to stimulate dental professionals to integrate smoking cessation interventions into primary care. Community Dental Health. 2012;29(2):154–61. Accessed on November 24, 2015

Citations - Evidence

Abrams 2010* - Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American Journal of Preventive Medicine. 2010;38(3 Suppl):S351-63. Accessed on November 23, 2015
Aveyard 2012* - Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: A systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107(6):1066–73. Accessed on November 23, 2015
Boyle 2010 - Boyle RG, Solberg LI, Fiore MC. Electronic medical records to increase the clinical treatment of tobacco dependence: A systematic review. American Journal of Preventive Medicine. 2010;39(6 Suppl 1):S77-82. Accessed on November 24, 2015
Cochrane-Boyle 2011* - Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews. 2011;(12):CD008743. Accessed on November 30, 2015
Cochrane-Carr 2012* - Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database of Systematic Reviews. 2012;(6):CD005084. Accessed on December 1, 2015
Cochrane-Lancaster 2000* - Lancaster T, Fowler G. Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews. 2000;(3):CD000214. Accessed on January 20, 2016
Cochrane-Rice 2013* - Rice VH, Hartmann-Boyce J, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Systematic Reviews. 2013;(8):CD001188. Accessed on December 14, 2015
Cochrane-Stead 2013* - Stead LF, Buitrago D, Preciado N, et al. Physician advice for smoking cessation. Cochrane Database Systematic Reviews. 2013;(5):CD000165. Accessed on December 14, 2015
Cokkinides 2008* - Cokkinides VE, Halpern MT, Barbeau EM, Ward E, Thun MJ. Racial and ethnic disparities in smoking-cessation interventions: Analysis of the 2005 national health interview survey. American Journal of Preventive Medicine. 2008;34(5):404-12. Accessed on December 8, 2015
Dent 2007* - Dent LA, Harris KJ, Noonan CW. Tobacco interventions delivered by pharmacists: A summary and systematic review. Pharmacotherapy. 2007;27(7):1040–51. Accessed on December 8, 2015
Feenstra 2005 - Feenstra TL, Hamberg-van Reenen HH, Hoogenveen RT, Rutten-van Mölken MPMH. Cost-effectiveness of face-to face smoking cessation interventions: A dynamic modeling study. Value In Health. 2005;8(3):178-90. Accessed on February 5, 2016
Freund 2009* - Freund M, Campbell E, Paul C, et al. Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect. Nicotine & Tobacco Research. 2009;11(6):650-62. Accessed on February 24, 2016
Gordon 2006* - Gordon JS, Lichtenstein E, Severson HH, Andrews JA. Tobacco cessation in dental settings: Research findings and future directions. Drug and Alcohol Review. 2006;25(1):27-37. Accessed on February 5, 2016
Hamilton 2013* - Hamilton F, Greaves F, Majeed A, Millett C. Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: Systematic review. Tobacco Control. 2013;22(1):3–8. Accessed on November 23, 2015
Patnode 2013 - Patnode CD, O’Connor E, Whitlock EP, et al. Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2013;158(4):253–60. Accessed on November 24, 2015
Pbert 2006 - Pbert L, Fletcher KE, Flint AJ, et al. Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics. 2006;118(3):e810-24. Accessed on May 24, 2016
Rosseel 2012* - Rosseel J, Jacobs J, Plasschaert A, Grol R. A review of strategies to stimulate dental professionals to integrate smoking cessation interventions into primary care. Community Dental Health. 2012;29(2):154–61. Accessed on November 24, 2015
Sonnenfeld 2009* - Sonnenfeld N, Schappert SM, Lin SX. Racial and ethnic differences in delivery of tobacco-cessation services. American Journal of Preventive Medicine. 2009;36(1):21-8. Accessed on May 24, 2016
US DHHS-Treating tobacco use - Tobacco Use and Dependence Guideline Panel. Treating tobacco use and dependence: 2008 Update. Rockville: US Department of Health and Human Services (US DHHS); 2008. Accessed on March 13, 2017

Citations - Implementation

NCQA 2013 - National Committee for Quality Assurance (NCQA). Improving quality and patient experience: The state of health care quality 2013. Washington, DC: National Committee for Quality Assurance (NCQA); 2013. Accessed on November 24, 2015

Page Last Updated

May 22, 2014

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