Patient Care Outcomes of a Tobacco Use Registry in an Academic Family Practice

Abstract

Purpose: While the potential benefit of a chronic disease registry for tobacco use is great, outcome reports have not been generated. We examined the effect of implementing a tobacco use registry, including a decision support tool, on treatment outcomes within an academic family medicine clinic.Methods: A chart review of 200 patients who smoked and attended the clinic before and after registry implementation assessed the number of patients with clinic notes documenting (1) counseling for tobacco use, (2) recommendations for cessation medication, (3) a set quit date, (4) referrals to the onsite Nicotine Dependence Program (NDP) and/or QuitlineNC, and (5) pneumococcal vaccine. Data from the NDP, QuitlineNC, and clinic billing records before and after implementation compared the number of clinic-generated QuitlineNC fax referrals, new scheduled appointments for the NDP, and visits coded for tobacco counseling reimbursement.Results: Significant increases in documentation occurred across most chart review variables. Significant increases in the number of clinic-generated fax referrals to QuitlineNC (from 27 to 96), initial scheduled appointments for the NDP (from 84 to 148), and coding for tobacco counseling (from 101 to 287) also occurred when compared with total patient visits during the same time periods. Patient attendance at the NDP (52%) and acceptance of QuitlineNC services (31%) remained constant. Tobacco use remains the leading cause of preventable disease and death in the United States, and smoking accounts for nearly half a million premature deaths annually.1 Because tobacco abstinence reduces tobacco-related morbidity and mortality, treating tobacco use should be a key component of providing high-quality health care to patients. Research has demonstrated the critical importance of the physician's role in tobacco use treatment. 2Clinical practice guidelines recommend that tobacco use be addressed at each office visit with brief interventions using the "5 As" (ask about tobacco use; advise cessation; assess willingness to quit, assist in a quit attempt; and arrange follow-up), combined with offers of pharmacotherapy. 3 Meta-analyses have found that brief interventions double-and the use of pharmacotherapy triples-a patient's chances of successfully quitting. 3Substantial progress has been made in tobacco use treatment interventions (eg, quit lines, medications, and feedback systems). Unfortunately, rates of counseling and offers of medication remain low. 4 This article was externally peer reviewed.

The Implementation of a Tobacco Use Registry in an Academic Family Practice

“…The biggest changes in confidence occurred with less commonly used medications, suggesting that some residents and faculty were perhaps previously unfamiliar with these evidence-based medications. Outcomes reported in the companion article, 14 based on a chart review, support the hypothesis that providers actually increased the number of cessation prescriptions provided to patients.…”

Bringing Patients Into the Patient-Centered Medical Home: Lessons Learned in a Large Primary Care Practice

“…There have been persistent calls for dramatic changes in the model of primary care-from reports by the National Academy of Medicine [3,4], from the Future of Family Medicine report [1], and from the Joint Statement on the Patient Centered Medical Home [5]. Following these leads, the UNC Family Medicine Center implemented advanced access [6,7], designed new coordinated systems of care for chronic disease (including diabetes and congestive heart failure) [8,9], and began to systematically address tobacco use in our practice [10,11]. We obtained and renewed PCMH recognition [12], embedded social work care management [13], launched a new home-based care service, implemented interventions to reduce hospital readmissions, and built a regional system of care for uninsured patients in collaboration with partners in the UNC Health Care System [14], Piedmont Health Services, and Community Care of Central Carolina.…”

Data Supporting Key Components of Family Medicine--Scope, Continuity, Interprofessional Care, and More

“…Certainly nurse triage and physician education would be places to start. Two companion articles are included in this issue, one on implementing a tobacco use registry 4 and the other on an accompanying decision support tool. 5 The registry went beyond merely noting whether patients smoked or not, and included various actions and status related to tobacco use.…”