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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Background: Tobacco is the leading cause of preventable death in the United States. The United States Public Health Service (PHS) urges physicians to follow the "5As" to help patients quit smoking: 1) Ask about tobacco use; 2) Advise patients to quit; 3) Assess willingness to quit; 4) Assist in quit attempt; and, 5) Arrange follow-up after the quit attempt. Studies have shown high rates of documenting tobacco use (Ask), but low rates for later steps. Electronic medical record (EMR)-assisted counseling and referral has the potential to enhance the care of patients in need of tobacco treatment by providing a structured approach to guideline adherence. The PBRN: The Brigham and Women's Primary Care Practice-Based Research Network (BWPC-PBRN) consists of 19 practices with 95 attending physicians who serve a diverse patient population. BWPC Clinics are linked organizationally and electronically with a common EMR that allows linkage of diagnostic, prescribing, and other clinical data. The BWPC-PBRN had 237,530 total patient visits in 2002. Ten percent of adult patients are active smokers. Research Plan: We propose to develop and evaluate a novel, tailored EMR-based intervention to increase smoking cessation counseling utilizing the "5A" approach in the BWPC-PBRN using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) theoretical model. Specific Aim 1 is to develop an EMR-based strategy for treating tobacco use, the Computerized EMR-Assisted Smoking Cessation Effort (CEASCE). CEASCE will provide reminders to document smoking status, a simple, templated mechanism for documentation of the 5As, easy access to smoking cessation medications, and 'one-click" referral to a smoking cessation counselor. Specific Aim 2 is to assess the Reach and Effectiveness ("RE") of CEASCE, by conducting a randomized controlled trial in the BWPC-PBRN to determine its effectiveness in increasing the proportion of smokers who receive treatment. The primary outcome is a key "Assist" in tobacco treatment: telephone contact with a smoking cessation counselor. Secondary outcomes include measures of other 5A steps: the proportion of patients for whom smoking status is documented (Ask), the proportion of smokers who receive advice to quit (Advise), the proportion of smokers asked about their willingness to quit (Assess), and the proportion of smokers who receive smoking cessation medication (Assist). Specific Aim 3 is to assess the Adoption, Implementation, and short-term Maintenance ("AIM") of CEASCE by measuring the proportion and characteristics of providers who use CEASCE, the consistency with which providers use the components of CEASCE, and changes in the use of CEASCE over time. Future Directions: Evaluate whether CEASCE can serve as a prototype for other common primary care problems that require counseling for behavior change.